Stacey M Campbell, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA01196 Issued in OR

Practice address

1151 May St
Suite 201
Hood River, OR 97031-1526

Phone

(541) 387-1300

Fax

(541) 386-6224

NPI assigned

Nov 3, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Electronic endpoints 1

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

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Columbia Gorge Medical Center PC

  • Clinic/Center
  • Hood River, OR
  • NPI 1558346064
  Medicare reassignment NPD
• Providence Health & Services Oregon

  • Critical Access Hospital
  • Hood River, OR
  • NPI 1255429338
  Medicare reassignment NPD
• Providence Health & Services Oregon

  • General Practice Physician
  • Lake Oswego, OR
  • NPI 1023488343
  Medicare reassignment
• Providence Health & Services Oregon

  • Clinical Pathology Physician
  • Hood River, OR
  • NPI 1053862714
  Medicare reassignment
• Providence Health & Services - Oregon

  • Cardiovascular Disease Physician
  • Tigard, OR
  • NPI 1588981963
  NPD
• Providence Health & Services Oregon

  • Rural Health Clinic/Center
  • Hood River, OR
  • NPI 1073100095
  NPD
• Providence Health & Services Oregon

  • Psychiatry Physician
  • Portland, OR
  • NPI 1760177737
  NPD

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613606400000",
    "number": "1942389408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3390",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1151 MAY ST",
            "address_2": "SUITE 201",
            "city": "HOOD RIVER",
            "state": "OR",
            "postal_code": "970311526",
            "telephone_number": "541-387-1300",
            "fax_number": "541-386-6224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "STACEY",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-03",
        "last_updated": "2021-02-18",
        "certification_date": "2021-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA10004739",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA01196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE (PH&S)-PMG",
            "identifier": "P00630499",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500600089",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8416539",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA STATE D L&I NUMBER",
            "identifier": "0142139",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "scampbell107648@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1151 May St",
            "address_2": "SUITE 201",
            "city": "Hood River",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970311526",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Roberto Bustos
• Jodie Butler
• Leah Buttaccio
• Leah Cain, LCSW
• Winston Eli Camero
• Jesica M Campos-Enriquez
• Amber Sobia Majid Cardinalli, D.O.
• Care Center (Hood River) Inc.
• Caring for Columbia Gorge LLC
• Alexis Breanne Carter

• Physician Assistant in Hood River, OR
• Providers in Hood River, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.