Individual provider Active NPI

Ekaterina Alexandrovna Rollason, PA

  • Physician Assistant
  • Medford, OR
National Provider Identifier
1851157366
Registry record updated Feb 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1600 Delta Waters Rd Ste 107
Medford, OR 97504-9114
Phone
(541) 734-9030
NPI assigned
Feb 22, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 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 OR Primary

Addresses

Primary practice location

1600 Delta Waters Rd Ste 107
Medford, OR 97504-9114

Mailing address

1600 Delta Waters Rd Ste 107
Medford, OR 97504-9114
Phone (541) 734-9030

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
I20240326001840 OR Practitioner - Physician Assistant 0648617696 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pain Care of Oregon LLCGroup PAC ID 3779550785, 12 clinicians

Practice addresses (Care Compare)

825 Bennett Ave
Medford, OR 97504-6715
Phone (541) 779-5228

Hospital & facility affiliations

National Provider Directory

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

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 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": "1708560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708560000000",
    "number": "1851157366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 DELTA WATERS RD STE 107",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975049114",
            "telephone_number": "541-734-9030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 DELTA WATERS RD STE 107",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975049114",
            "telephone_number": "541-734-9030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROLLASON",
        "first_name": "EKATERINA",
        "middle_name": "ALEXANDROVNA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-22",
        "last_updated": "2024-02-22",
        "certification_date": "2024-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.