Individual provider Active NPI

Lily Barbara Summer, PA-C

  • Physician Assistant
  • Portland, OR
National Provider Identifier
1811724727
Registry record updated Sep 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA222519 Issued in OR
Practice address
3036 NE Martin Luther King Jr Blvd
Portland, OR 97212-3053
Phone
(503) 674-7777
NPI assigned
Sep 16, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA222519 OR Primary

Addresses

Primary practice location

3036 NE Martin Luther King Jr Blvd
Portland, OR 97212-3053

Mailing address

847 NE 19TH Ave Ste 100
Portland, OR 97232-2684

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
I20241023004103 OR Practitioner - Physician Assistant 6002349412 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Cascadia HealthGroup PAC ID 7618873761, 53 clinicians

Practice addresses (Care Compare)

3036 NE MLK Jr Blvd
Portland, OR 97212-3053
Phone (503) 889-2500

707 NW Everett St
Portland, OR 97209-3517
Phone (503) 222-4906

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA222519ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cascadia Health CurrentSince Oct 21, 2024 Accepting new patients
Cascadia Health Past Accepting new patients

Locations

4212 SE Division St
Ste 100
Portland, OR 97206
Phone (503) 238-0705

847 NE 19th Ave
Ste 100
Portland, OR 97232
Phone (503) 552-6203

3036 NE Mlk Jr Blvd
Portland, OR 97212
Phone (503) 283-3763

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 5

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": "1726444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726444800000",
    "number": "1811724727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "847 NE 19TH AVE STE 100",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3036 NE MARTIN LUTHER KING JR BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972123053",
            "telephone_number": "503-674-7777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUMMER",
        "first_name": "LILY",
        "middle_name": "BARBARA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-16",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA222519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.