Individual provider Active NPI

John T. Davis, PA-C

  • Physician Assistant
  • Medford, OR
National Provider Identifier
1881971836
Registry record updated May 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA161246 Issued in OR
Practice address
2828 E Barnett Rd
Medford, OR 97504-8342
Phone
(541) 774-5853
NPI assigned
Nov 4, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2013

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 2049 OK
Physician Assistant 363A00000X PA161246 OR Primary

Addresses

Primary practice location

2828 E Barnett Rd
Medford, OR 97504-8342

Mailing address

2828 E Barnett Rd
Medford, OR 97504-8342
Phone (541) 774-5853

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
I20131004000466 OR Practitioner - Physician Assistant 2264690858 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Peacehealth Networks on Demand LLCGroup PAC ID 1759731383, 197 clinicians

Practice addresses (Care Compare)

10221 SE Sunnyside Rd
Clackamas, OR 97015-9782
Phone (864) 664-3984

11355 SW Scholls Ferry Rd
Beaverton, OR 97008-7167
Phone (864) 664-3984

11956 SW Garden PL
Tigard, OR 97223-8248
Phone (503) 684-8252

7451 SW Bridgeport Rd
Tigard, OR 97224-7207
Phone (864) 664-3984

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2049OKMDOptometrist
PA161246ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Zoomcare PC Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/30646/brand/1/csg/1/fhir/r4

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.

NPI Registry JSON

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

{
    "created_epoch": "1320364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369872000000",
    "number": "1881971836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2828 E BARNETT RD",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048342",
            "telephone_number": "541-774-5853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2828 E BARNETT RD",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048342",
            "telephone_number": "541-774-5853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JOHN",
        "middle_name": "T.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-11-04",
        "last_updated": "2013-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "2049",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA161246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.