NPIMap

Individual provider Active NPI

Heidi Susanne Dyer, PA-C

  • Physician Assistant
  • Wilsonville, OR
National Provider Identifier
1922150580
Registry record updated Oct 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA01447 Issued in OR
Practice address
29345 SW Town Center Loop E
Suite 110
Wilsonville, OR 97070-8486
Phone
(503) 582-2100
NPI assigned
Jan 16, 2007
Last updated
Oct 23, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2025

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 PA01447 OR Primary
Medical Physician Assistant 363AM0700X PA652 ID

Addresses

Primary practice location

29345 SW Town Center Loop E
Suite 110
Wilsonville, OR 97070-8486

Mailing address

PO Box 3777
Portland, OR 97208-3777

Other practice location 1

19250 SW 65th Ave Ste 137
Tualatin, OR 97062-7745
Phone (503) 413-5702

Other identifiers 1

IdentifierTypeStateIssuer
500609968MedicaidOR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address hdyer310048@oc.providencedirect.org

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
I20090324000104 OR Practitioner - Physician Assistant 6901981687 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Legacy Clinics LLCGroup PAC ID 0244144004, 714 clinicians

Practice addresses (Care Compare)

19250 SW 65TH Ave
Suite 137
Tualatin, OR 97062-7745
Phone (503) 413-7074

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA652IDMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Clinics LLC CurrentSince Sep 18, 2025 Accepting new patients
Legacy Clinics LLC CurrentSince Sep 18, 2025 Accepting new patients

Locations

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

19250 SW 65th Ave
Ste 137
Tualatin, OR 97062
Phone (503) 413-5702

Interoperability endpoints

  • Direct secure messaging: hdyer1588886@direct.lhs.org
  • Direct secure messaging: hdyer310048@oc.providencedirect.org

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": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761177600000",
    "number": "1922150580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3777",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29345 SW TOWN CENTER LOOP E",
            "address_2": "SUITE 110",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970708486",
            "telephone_number": "503-582-2100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19250 SW 65th Ave Ste 137",
            "address_purpose": "LOCATION",
            "city": "Tualatin",
            "state": "OR",
            "postal_code": "970627745",
            "country_code": "US",
            "telephone_number": "503-413-5702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DYER",
        "first_name": "HEIDI",
        "middle_name": "SUSANNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-16",
        "last_updated": "2025-10-23",
        "certification_date": "2025-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA01447",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA652",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500609968",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hdyer310048@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "29345 SW Town Center Loop E",
            "address_2": "SUITE 110",
            "city": "Wilsonville",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970708486",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wilsonville, OR

Sources for this page

Verify at the official NPI Registry.