Active NPI
Amelia H Johnson, PA-C
- Physician Assistant
- Portland, OR
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA159647
- Practice address
- 300 N Graham St Ste 125
Portland, OR 97227-1683 - Phone
- (503) 528-0704
- NPI assigned
- Oct 16, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA159647 | OR | Primary |
Addresses
Primary practice location
300 N Graham St Ste 125
Portland, OR 97227-1683
Mailing address
134 W Chrisfield Dr
Meridian, ID 83646-3255
Phone (541) 232-1314
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1130 NW 22ND Ave
Suite 220
Portland, OR 97210-2969
Phone (503) 413-8988
2801 N Gantenbein Ave
Portland, OR 97227-1623
Phone (503) 413-1122
Hospital & facility affiliations
- Legacy Emanuel Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 94.62 of 100
- 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
| License | State | Type | Specialty |
|---|---|---|---|
| PA159647 | OR | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Legacy Clinics LLC | Current | Accepting new patients |
Locations
2850 SE Powell Valley Rd
Gresham, OR 97080
Phone (503) 666-5050
25050 SE Stark St
Ste 265
Gresham, OR 97030
Phone (503) 413-2005
2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200
1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134
300 N Graham St
Ste 125
Portland, OR 97227
Phone (503) 413-3714
Organizations & group practices 1
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.
-
- Clinic/Center
- Portland, OR
- NPI 1902827272
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Portland, OR
- NPI 1003367491
-
- Clinical Medical Laboratory
- Portland, OR
- NPI 1295756898
Hospital
-
- General Acute Care Hospital
- Portland, OR
- NPI 1831112358
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1576022400000",
"number": "1962755801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "134 W CHRISFIELD DR",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836463255",
"telephone_number": "541-232-1314"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 N GRAHAM ST STE 125",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972271683",
"telephone_number": "503-528-0704"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "AMELIA",
"middle_name": "H",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-16",
"last_updated": "2019-12-11",
"certification_date": "2019-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OR",
"license": "PA159647",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2019; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.