Individual provider Active NPI

Francisco Javier Pena, PA

  • Surgical Physician Assistant
  • Portland, OR
National Provider Identifier
1710479720
Registry record updated Jul 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
Practice address
2730 SW Moody Ave
Portland, OR 97201-5042
Phone
(503) 494-8311
NPI assigned
Jun 5, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Surgical Physician Assistant 363AS0400X Primary

Addresses

Primary practice location

2730 SW Moody Ave
Portland, OR 97201-5042

Mailing address

2865 Daggett Ave
Klamath Falls, OR 97601-1106
Phone (541) 882-6311

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
I20200110001484 OR Practitioner - Physician Assistant 2769817204 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Oregon Health Sciences University School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sky Lakes Medical Center IncGroup PAC ID 1052204096, 196 clinicians

Practice addresses (Care Compare)

2301 Clairmont Dr
Klamath Falls, OR 97601-7104
Phone (541) 274-8630

2821 Daggett Ave
Suite 100
Klamath Falls, OR 97601-1106
Phone (541) 274-6733

2865 Daggett Ave
Klamath Falls, OR 97601-1106
Phone (541) 274-6221

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sky Lakes Medical Center Inc CurrentSince Dec 2, 2019 Accepting new patients

Locations

2865 Daggett Ave
Klamath Falls, OR 97601
Phone (541) 833-6221

3000 Bryant Williams Dr
Ste 110
Klamath Falls, OR 97601
Phone (541) 274-2345

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 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": "1528156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564012800000",
    "number": "1710479720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2865 DAGGETT AVE",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976011106",
            "telephone_number": "541-882-6311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2730 SW MOODY AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972015042",
            "telephone_number": "503-494-8311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENA",
        "first_name": "FRANCISCO",
        "middle_name": "JAVIER",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-05",
        "last_updated": "2019-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.