NPIMap

Individual provider Active NPI

Kendall Hall

  • Medical Physician Assistant
  • Tigard, OR
National Provider Identifier
1790379733
Registry record updated Oct 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA211820 Issued in OR
Practice address
12123 SW 69TH Ave
Tigard, OR 97223-8514
Phone
(971) 708-7600
NPI assigned
Feb 20, 2021
Last updated
Oct 7, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2024

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 PA211820 OR Primary

Addresses

Primary practice location

12123 SW 69TH Ave
Tigard, OR 97223-8514

Mailing address

1498 SE Tech Center PL Ste 240
Vancouver, WA 98683-5508
Phone (360) 597-1313

Other practice location 1

2730 S Moody Ave
Portland, OR 97201-5042
Phone (503) 494-3633

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
I20230821000713 OR Practitioner - Physician Assistant 9032571203 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Oregon Health Sciences University School of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northwest Cancer Specialists PCGroup PAC ID 8426943838, 70 clinicians

Practice addresses (Care Compare)

12123 SW 69TH Ave
Tigard, OR 97223-8514
Phone (971) 708-7600

265 N Broadway
Portland, OR 97227-1800
Phone (503) 280-1223

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA211820ORMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Cancer Specialists PC CurrentSince Aug 2, 2023 Accepting new patients
Northwest Cancer Specialists PC CurrentSince Aug 2, 2023 Accepting new patients

Locations

265 N Broadway
Portland, OR 97227
Phone (503) 280-1223

12123 SW 69th Ave
Tigard, OR 97223
Phone (971) 708-7600

1498 SE Tech Center Pl
Ste 240
Vancouver, WA 98683
Phone (360) 597-1309

210 SE 136th Ave
Vancouver, WA 98684
Phone (360) 944-9889

Interoperability endpoints

  • Direct secure messaging: kendall.hall@compass.ikm.direct-ci.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1613779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728259200000",
    "number": "1790379733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1498 SE TECH CENTER PL STE 240",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986835508",
            "telephone_number": "360-597-1313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12123 SW 69TH AVE",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972238514",
            "telephone_number": "971-708-7600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2730 S Moody Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972015042",
            "country_code": "US",
            "telephone_number": "503-494-3633",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HALL",
        "first_name": "KENDALL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-20",
        "last_updated": "2024-10-07",
        "certification_date": "2024-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA211820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tigard, OR

Sources for this page

Verify at the official NPI Registry.