Individual provider Active NPI

Christina Leila Thompson, PA-C

  • Medical Physician Assistant
  • Portland, OR
National Provider Identifier
1659622819
Registry record updated Nov 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA174608 Issued in OR
Practice address
1111 NE 99TH Ave
Portland, OR 97220-9428
Phone
(503) 963-2707
Fax
(503) 963-2802
NPI assigned
Sep 27, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 015985-1 NY
Medical Physician Assistant 363AM0700X PA174608 OR Primary

Addresses

Primary practice location

1111 NE 99TH Ave
Portland, OR 97220-9428

Mailing address

541 NE 20TH Ave Ste 225
Portland, OR 97232-2895
Phone (503) 963-2801

Other identifiers 2

IdentifierTypeStateIssuer
2049303MedicaidWA
500694968MedicaidOR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cc_otoc_gastro_east_front_desk_pool12223282@oc.providencedirect.org The Oregon Clinic PC

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151207002337 OR Practitioner - Physician Assistant 6608193545 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Oregon Clinic, PCGroup PAC ID 2860390408, 353 clinicians

Practice addresses (Care Compare)

1111 NE 99TH Ave
Portland, OR 97220-9442

4805 NE Glisan
Portland, OR 97213-2933

5050 NE Hoyt
Suite 655
Portland, OR 97213-2990
Phone (503) 239-6673

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
015985-1NYMDSpecialist
PA174608ORMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Oregon Clinic, PC CurrentSince Nov 16, 2015 Accepting new patients

Locations

541 NE 20th Ave
Ste 225
Portland, OR 97232
Phone (503) 963-2801

5050 NE Hoyt St
Ste 655
Portland, OR 97213
Phone (503) 239-6673

1111 NE 99th Ave
Ste 301
Portland, OR 97220
Phone (503) 963-2707

1111 NE 99th Ave
Portland, OR 97220
Phone (503) 963-2707

Interoperability endpoints

  • Direct secure messaging: cthompson566149@oc.providencedirect.org

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1348704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730678400000",
    "number": "1659622819",
    "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",
            "fax_number": "503-963-2825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 NE 99TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972209428",
            "telephone_number": "503-963-2707",
            "fax_number": "503-963-2802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "CHRISTINA",
        "middle_name": "LEILA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-27",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "015985-1",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA174608",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2049303",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500694968",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cc_otoc_gastro_east_front_desk_pool12223282@oc.providencedirect.org",
            "affiliation": "Y",
            "affiliationName": "The Oregon Clinic PC",
            "address_1": "1111 NE 99th Ave",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972209428",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.