Lisa Blakley, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA220196 Issued in OR

Practice address

2222 NW Lovejoy St Ste 422
Portland, OR 97210-5102

Phone

(503) 227-7117

Fax

(503) 227-7120

NPI assigned

Jan 17, 2024

Last updated

Feb 24, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

May accept Medicare assignment

Group practices

Epiphany Dermatology of Oregon LLCGroup PAC ID 0345144093, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: lblakley3262327@oc.providencedirect.org

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.

• Epiphany Dermatology of Oregon, LLC

  • Dermatology Physician
  • Portland, OR
  • NPI 1174697239
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1705449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740355200000",
    "number": "1649031642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 NE 20TH AVE STE 225",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322895",
            "telephone_number": "503-963-2801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 NW LOVEJOY ST STE 422",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972105102",
            "telephone_number": "503-227-7117",
            "fax_number": "503-227-7120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKLEY",
        "first_name": "LISA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-17",
        "last_updated": "2025-02-24",
        "certification_date": "2025-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA220196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cc_otoc_neurosurgery_front_desk_pool12223185@oc.providencedirect.org",
            "affiliation": "Y",
            "affiliationName": "The Oregon Clinic PC",
            "address_1": "9155 SW Barnes Rd Ste 440",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972256631",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Thomas Lawrence Blakely, CCC-SLP
• Cortney C Blakemore, CRNA
• Rachel Hope Blakemore, OD
• Patricia Evans Blakeslee, L.AC., R.N.
• David Blakey
• Anne Elizabeth Blanchard, PSS, CRM
• Catherine Blanchard, LPC, MA, CADC1
• Cynthia Blanchard, CSWA
• Deborah A Blanchard, DO
• Isabelle Blanchard

• Physician Assistant in Portland, OR
• Providers in Portland, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2025; 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.

Verify at the official NPI Registry.