Individual provider Active NPI

Andrew Stanton, PA-C

  • Surgical Physician Assistant
  • Portland, OR
National Provider Identifier
1982179560
Registry record updated May 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA190662 Issued in OR
Practice address
11782 SW Barnes Rd
Portland, OR 97225-5914
Phone
(503) 214-5200
NPI assigned
Oct 10, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2022

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 PA190662 OR
Surgical Physician Assistant 363AS0400X PA190662 OR Primary

Addresses

Primary practice location

11782 SW Barnes Rd
Portland, OR 97225-5914

Mailing address

3890 SW 94TH Ave
Portland, OR 97225-2507

Other practice location 1

14795 SW Murray Scholls Dr Ste 109
Beaverton, OR 97007-9230
Phone (503) 906-4301

Other identifiers 2

IdentifierTypeStateIssuer
PA190662OtherORPA LICENSE
500754932MedicaidOR

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
I20190228001627 OR Practitioner - Physician Assistant 9234478785 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

11782 SW Barnes Rd
Suite 300
Portland, OR 97225-5933
Phone (503) 214-5200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
54.33 of 100Reported as group
Quality
57.12
Promoting interoperability
0
Improvement activities
30
Cost
86.48

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA190662ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedic & Fracture Clinic PC Surgical CurrentSince Nov 12, 2018 Accepting new patients

Locations

14795 SW Murray Scholls Dr
Ste 109
Beaverton, OR 97007
Phone 5039064301 ext. 4301

11782 SW Barnes Rd
Portland, OR 97225
Phone (503) 214-5200

11782 SW Barnes Rd
Ste 300
Portland, OR 97225
Phone (503) 214-5200

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.

Hospital & facility affiliations 1

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": "1539129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653264000000",
    "number": "1982179560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3890 SW 94TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972252507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11782 SW BARNES RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255914",
            "telephone_number": "503-214-5200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14795 SW Murray Scholls Dr Ste 109",
            "address_purpose": "LOCATION",
            "city": "Beaverton",
            "state": "OR",
            "postal_code": "970079230",
            "country_code": "US",
            "telephone_number": "503-906-4301",
            "fax_number": "503-906-6613",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STANTON",
        "first_name": "ANDREW",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-10",
        "last_updated": "2022-05-23",
        "certification_date": "2022-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA190662",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OR",
            "license": "PA190662",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA LICENSE",
            "identifier": "PA190662",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500754932",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.