NPIMap

Individual provider Active NPI

Carli McCormick, PA

  • Physician Assistant
  • Lake Oswego, OR
National Provider Identifier
1972329563
Registry record updated Jan 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA222750 Issued in OR
Practice address
4103 Mercantile Dr
Lake Oswego, OR 97035-2556
Phone
(503) 850-9940
NPI assigned
Nov 27, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA222750 OR Primary

Addresses

Primary practice location

4103 Mercantile Dr
Lake Oswego, OR 97035-2556

Mailing address

4103 Mercantile Dr
Lake Oswego, OR 97035-2556

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
I20250311000639 OR Practitioner - Physician Assistant 3274054945 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Touro Un Col of Osteopathic Medicine, Henderson, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Orthopaedics, LLPGroup PAC ID 4789725607, 18 clinicians

Practice addresses (Care Compare)

4103 Mercantile Dr
Lake Oswego, OR 97035-2556
Phone (503) 850-9940

Hospital & facility affiliations

  • Legacy Emanuel Medical Center Hospital, Portland, OR, CCN 380007
  • Legacy Mount Hood Medical Center Hospital, Gresham, OR, CCN 380025
  • Legacy Meridian Park Medical Center Hospital, Tualatin, OR, CCN 380089
  • Legacy Salmon Creek Medical Center Hospital, Vancouver, WA, CCN 500150

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
TS Pos Billings L L C Past Accepting new patients

Organizations & group practices 3

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 8

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": "1732665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736035200000",
    "number": "1972329563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4103 MERCANTILE DR",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970352556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4103 MERCANTILE DR",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970352556",
            "telephone_number": "503-850-9940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCORMICK",
        "first_name": "CARLI",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-27",
        "last_updated": "2025-01-05",
        "certification_date": "2025-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA222750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Oswego, OR

Sources for this page

Verify at the official NPI Registry.