Active NPI
Taylor Alysa Pottratz
- Physician Assistant
- Lake Oswego, OR
National Provider Identifier
1619532884
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA204779
- Practice address
- 123 C Ave
Lake Oswego, OR 97034-2353 - Phone
- (503) 905-9006
- Fax
- (541) 210-8913
- NPI assigned
- May 3, 2019
- Last updated
- Oct 4, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA204779 | OR | Primary |
Addresses
Primary practice location
123 C Ave
Lake Oswego, OR 97034-2353
Mailing address
123 C Ave
Lake Oswego, OR 97034-2353
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
123 C Ave
Lake Oswego, OR 97034-2353
Phone (541) 316-6575
Merit-based Incentive Payment System (MIPS)
- Final score
- 100 of 100
- Quality
- 100
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1556841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633305600000",
"number": "1619532884",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "123 C AVE",
"city": "LAKE OSWEGO",
"state": "OR",
"postal_code": "970342353"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "123 C AVE",
"city": "LAKE OSWEGO",
"state": "OR",
"postal_code": "970342353",
"telephone_number": "503-905-9006",
"fax_number": "541-210-8913"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTTRATZ",
"first_name": "TAYLOR",
"middle_name": "ALYSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-05-03",
"last_updated": "2021-10-04",
"certification_date": "2021-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physician Assistant",
"state": "OR",
"license": "PA204779",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Oswego, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.