Individual provider Active NPI

Mimi Maria Hughes, PA

  • Physician Assistant
  • Milwaukie, OR
National Provider Identifier
1720315070
Registry record updated Aug 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA150640 Issued in OR
Practice address
4560 SE International Way Ste 100
Milwaukie, OR 97222-4628
Phone
(971) 206-5179
NPI assigned
Nov 6, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2020

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 PA150640 OR Primary
Medical Physician Assistant 363AM0700X PA11905 CA

Addresses

Primary practice location

4560 SE International Way Ste 100
Milwaukie, OR 97222-4628

Mailing address

4560 SE International Way Ste 100
Milwaukie, OR 97222-4628
Phone (971) 206-5179

Other identifiers 1

IdentifierTypeStateIssuer
500619040MedicaidOR

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

State licenses

LicenseStateTypeSpecialty
PA150640ORMDPhysician Assistant
PA11905CAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia Pharmacy LLC PastSince Jun 21, 2020 Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1257465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597017600000",
    "number": "1720315070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4560 SE INTERNATIONAL WAY STE 100",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972224628",
            "telephone_number": "971-206-5179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4560 SE INTERNATIONAL WAY STE 100",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972224628",
            "telephone_number": "971-206-5179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUGHES",
        "first_name": "MIMI",
        "middle_name": "MARIA",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-06",
        "last_updated": "2020-08-10",
        "certification_date": "2020-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA150640",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA11905",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500619040",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukie, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2020; 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.