Individual provider Active NPI

Loan Duong, PA-C

  • Physician Assistant
  • Gresham, OR
National Provider Identifier
1952858300
Registry record updated Mar 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA179171 Issued in OR
Practice address
24988 SE Stark St
Gresham, OR 97030-8322
Phone
(503) 413-5702
NPI assigned
Sep 1, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA179171 OR Primary
Medical Physician Assistant 363AM0700X PA179171 OR
Medical Physician Assistant 363AM0700X 60687602 WA

Addresses

Primary practice location

24988 SE Stark St
Gresham, OR 97030-8322

Mailing address

16655 NE Oregon St
Portland, OR 97230-5891
Phone (503) 415-1325

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
I20161031001573 OR Practitioner - Physician Assistant 0244518983 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
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)

1130 NW 22ND Ave
Suite 220
Portland, OR 97210-2969
Phone (503) 413-8988

25050 SE Stark St
Gresham, OR 97030-3383
Phone (503) 674-1848

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.62 of 100Reported as apm
Quality
77.21
Promoting interoperability
99.06
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA179171ORMDPhysician Assistant
60687602WAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Clinics LLC CurrentSince Nov 14, 2016 Accepting new patients
Legacy Salmon Creek Hospital Past Accepting new patients

Locations

25050 SE Stark St
Gresham, OR 97030
Phone (503) 413-5702

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

2222 NW Lovejoy St
Ste 411
Portland, OR 97210
Phone (503) 413-5702

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

Interoperability endpoints

  • Direct secure messaging: lduong192408@direct.lhs.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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1472688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710892800000",
    "number": "1952858300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16655 NE OREGON ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972305891",
            "telephone_number": "503-415-1325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24988 SE STARK ST",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970308322",
            "telephone_number": "503-413-5702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUONG",
        "first_name": "LOAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-01",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA179171",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA179171",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "60687602",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gresham, OR

Sources for this page

Verify at the official NPI Registry.