Active NPI
Joslyn Gibson, PA-C
- Physician Assistant
- Bend, OR
National Provider Identifier
1992184212
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA179204
- Practice address
- 2600 NE Neff Rd
Bend, OR 97701-6337 - Phone
- (541) 706-4800
- Fax
- (541) 706-4806
- NPI assigned
- May 19, 2015
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physician Assistant | 363A00000X | PA179204 | OR | Primary |
Addresses
Primary practice location
2600 NE Neff Rd
Bend, OR 97701-6337
Mailing address
501 N Graham St
Suite #415
Portland, OR 97227-1654
Phone (503) 413-3580
Other practice location 1
501 N Graham St
Suite #415
Portland, OR 97227-1654
Phone (503) 413-3580
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
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230814001494 | OR | Order and Referring Only - Physician Assistant | 9436431756 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA179204 | OR | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1431993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688083200000",
"number": "1992184212",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 N GRAHAM ST",
"address_2": "SUITE #415",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972271654",
"telephone_number": "503-413-3580"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2600 NE NEFF RD",
"city": "BEND",
"state": "OR",
"postal_code": "977016337",
"telephone_number": "541-706-4800",
"fax_number": "541-706-4806"
}
],
"practiceLocations": [
{
"address_1": "501 N Graham St",
"address_2": "Suite #415",
"address_purpose": "LOCATION",
"city": "Portland",
"state": "OR",
"postal_code": "972271654",
"country_code": "US",
"telephone_number": "503-413-3580",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GIBSON",
"first_name": "JOSLYN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-05-19",
"last_updated": "2023-06-30",
"certification_date": "2023-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OR",
"license": "PA179204",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2023; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.