Active NPI
Carol Lynne Sticker, PA-C
- Medical Physician Assistant
- Portland, OR
National Provider Identifier
1639375405
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA194156
- Practice address
- 4805 NE Glisan St Ste 6N60
Portland, OR 97213-2933 - Phone
- (503) 215-5526
- Fax
- (503) 416-7377
- NPI assigned
- Jun 26, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA194156 | OR | Primary |
| Physician Assistant | 363A00000X | WA |
Addresses
Primary practice location
4805 NE Glisan St Ste 6N60
Portland, OR 97213-2933
Mailing address
847 NE 19TH Ave Ste 300
Portland, OR 97232-2686
Phone (503) 963-2801
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500605459 | Medicaid | OR | |
| 2000682 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Planned Parenthood of the Columbia/Willamette, Inc. | Past | Accepting new patients | |
| My Other Me | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Gynecology Physician
- Portland, OR
- NPI 1801462080
-
- Multi-Specialty Clinic/Center
- Portland, OR
- NPI 1053311860
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616371200000",
"number": "1639375405",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "847 NE 19TH AVE STE 300",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972322686",
"telephone_number": "503-963-2801",
"fax_number": "503-963-2825"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4805 NE GLISAN ST STE 6N60",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972132933",
"telephone_number": "503-215-5526",
"fax_number": "503-416-7377"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STICKER",
"first_name": "CAROL",
"middle_name": "LYNNE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-26",
"last_updated": "2021-03-22",
"certification_date": "2021-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "OR",
"license": "PA194156",
"primary": true
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WA",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500605459",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2000682",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.