Individual provider Active NPI

Patrick Thomas Hassenfritz, ARNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Camas, WA
National Provider Identifier
1992348999
Registry record updated Sep 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
61014092 Issued in WA
Practice address
1625 SE 192ND Ave Ste 206
Camas, WA 98607-6508
Phone
(971) 352-4413
Fax
(971) 302-4787
NPI assigned
Oct 22, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 61014092 WA Primary

Addresses

Primary practice location

1625 SE 192ND Ave Ste 206
Camas, WA 98607-6508

Mailing address

7634 N Albina Ave
Portland, OR 97217-1308
Phone (503) 781-0840

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
I20210127003171 OR Practitioner - Nurse Practitioner 7911311204 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
61014092WAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Broadway Medical Clinic LLP CurrentSince Feb 1, 2021 Accepting new patients

Locations

4212 NE Broadway
Portland, OR 97213
Phone (503) 249-8787

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1571702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727222400000",
    "number": "1992348999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7634 N ALBINA AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972171308",
            "telephone_number": "503-781-0840",
            "fax_number": "971-302-4787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 SE 192ND AVE STE 206",
            "city": "CAMAS",
            "state": "WA",
            "postal_code": "986076508",
            "telephone_number": "971-352-4413",
            "fax_number": "971-302-4787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HASSENFRITZ",
        "first_name": "PATRICK",
        "middle_name": "THOMAS",
        "name_prefix": "Mr.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-22",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "61014092",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Camas, WA

Sources for this page

Verify at the official NPI Registry.