Johnny Wayne Siniscal, PHYSICANS ASSISTANT

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

OR PA 00079 Issued in OR

Practice address

10100 SE Sunnyside Rd
Clackamas, OR 97015-8970

Phone

(503) 571-8278

Fax

(503) 571-2740

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669583340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20770 SW SANDRA LN",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970061846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10100 SE SUNNYSIDE RD",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970158970",
            "telephone_number": "503-571-8278",
            "fax_number": "503-571-2740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SINISCAL",
        "first_name": "JOHNNY",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "credential": "PHYSICANS ASSISTANT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OR",
            "license": "OR PA 00079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew F. Simons, M.D.
• Mackenna Marie Simpson, PA-C
• Silvia Daina Sims, MD
• Malini Singh, DO
• Matthew Alan Singler, D.C.
• Anne Sinkey, M.S.W.
• Mark Gerald Sinkovitz, PTA
• Julia Sirianni, O.D.
• Diana Watsky Sirkin, OTR/L, CHT
• Amber Sirstad, LPC

• Surgical Physician Assistant in Clackamas, OR
• Providers in Clackamas, OR by specialty
• Surgical Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.