Individual provider Active NPI

Lynette Christine Spjut, PA-C

  • Medical Physician Assistant
  • Portland, OR
National Provider Identifier
1962694976
Registry record updated Nov 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA01462 Issued in OR
Practice address
1111 NE 99TH Ave Ste 200
Portland, OR 97220-9442
Phone
(503) 963-3030
Fax
(503) 963-3140
NPI assigned
Aug 14, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2023

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 PA60072217 WA
Medical Physician Assistant 363AM0700X PA01462 OR Primary

Addresses

Primary practice location

1111 NE 99TH Ave Ste 200
Portland, OR 97220-9442

Mailing address

541 NE 20TH Ave Ste 225
Portland, OR 97232-2895
Phone (503) 963-2801

Other identifiers 2

IdentifierTypeStateIssuer
500607345MedicaidOR
1962694976MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address referringpulm@1243.direct.myezyaccess.com The Oregon Clinic PC

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
I20090811000182 OR Practitioner - Physician Assistant 3072667013 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Oregon Clinic, PCGroup PAC ID 2860390408, 353 clinicians

Practice addresses (Care Compare)

1111 NE 99TH Ave
Portland, OR 97220-9442

5050 NE Hoyt
Suite 655
Portland, OR 97213-2990
Phone (503) 239-6673

Hospital & facility affiliations

  • Providence Portland Medical Center Hospital, Portland, OR, CCN 380061
  • Providence Milwaukie Hospital Hospital, Milwaukie, OR, CCN 380082

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The Oregon Clinic, PC CurrentSince Feb 1, 2021 Accepting new patients

Locations

1111 NE 99th Ave
Ste 200
Portland, OR 97220
Phone (503) 216-5435

5050 NE Hoyt St
Ste 655
Portland, OR 97213
Phone (503) 239-6673

541 NE 20th Ave
Ste 225
Portland, OR 97232
Phone (503) 963-2801

Interoperability endpoints

  • Direct secure messaging: lspjut1628520@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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1187049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700524800000",
    "number": "1962694976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 NE 20TH AVE STE 225",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322895",
            "telephone_number": "503-963-2801",
            "fax_number": "503-963-2825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 NE 99TH AVE STE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972209442",
            "telephone_number": "503-963-3030",
            "fax_number": "503-963-3140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPJUT",
        "first_name": "LYNETTE",
        "middle_name": "CHRISTINE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-14",
        "last_updated": "2023-11-21",
        "certification_date": "2023-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60072217",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA01462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500607345",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1962694976",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "referringpulm@1243.direct.myezyaccess.com",
            "affiliation": "Y",
            "affiliationName": "The Oregon Clinic PC",
            "address_1": "1111 NE 99th Ave Ste 200",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972209442",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.