NPIMap

Individual provider Active NPI

Geoffrey Xiao, PA-C

  • Medical Physician Assistant
  • Tigard, OR
National Provider Identifier
1790132017
Registry record updated Nov 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA178428 Issued in OR
Practice address
15895 SW 72ND Ave Ste 250
Tigard, OR 97224-7966
Phone
(503) 624-5630
Fax
(503) 624-9149
NPI assigned
May 17, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 26, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA178428 OR Primary

Addresses

Primary practice location

15895 SW 72ND Ave Ste 250
Tigard, OR 97224-7966

Mailing address

1840 E Ray Rd
Chandler, AZ 85225-8720
Phone (855) 397-0197

Other practice location 1

1547 NE 40th Ave Ste B
Portland, OR 97232-1862
Phone (503) 284-1937

Other identifiers 2

IdentifierTypeStateIssuer
2079317MedicaidWA
500717752MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160824002171 OR Practitioner - Physician Assistant 7618262015 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oregon Kidney and Hypertension Clinic LLCGroup PAC ID 6608316617, 2 clinicians
CRM Physicians LLCGroup PAC ID 3678720729, 59 clinicians

Practice addresses (Care Compare)

15895 SW 72ND Ave
Suite 250
Portland, OR 97224-7966
Phone (503) 624-5630

650 SE Oak St
Hillsboro, OR 97123-4120
Phone (503) 648-8588

Hospital & facility affiliations

  • Legacy Meridian Park Medical Center Hospital, Tualatin, OR, CCN 380089
  • Ohsu Hospital and Clinics Hospital, Portland, OR, CCN 380009
  • Adventist Health Portland Hospital, Portland, OR, CCN 380060
  • Providence Willamette Falls Medical Center Hospital, Oregon City, OR, CCN 380038
  • Salem Hospital Hospital, Salem, OR, CCN 380051

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA178428ORMDMedical Physician Assistant

Interoperability endpoints

  • Direct secure messaging: geoff.xiao@direct.davitaphysiciansolutions.com

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 6

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": "1463443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574726400000",
    "number": "1790132017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1840 E RAY RD",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852258720",
            "telephone_number": "855-397-0197",
            "fax_number": "800-272-6512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15895 SW 72ND AVE STE 250",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247966",
            "telephone_number": "503-624-5630",
            "fax_number": "503-624-9149"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1547 NE 40th Ave Ste B",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972321862",
            "country_code": "US",
            "telephone_number": "503-284-1937",
            "fax_number": "503-434-1190",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "XIAO",
        "first_name": "GEOFFREY",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-05-17",
        "last_updated": "2019-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA178428",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2079317",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500717752",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tigard, OR

Sources for this page

Verify at the official NPI Registry.