Individual provider Active NPI

Brooks Douglas Hanson, PA-C

  • Physician Assistant
  • Vancouver, WA
National Provider Identifier
1992514780
Registry record updated Dec 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA228046 Issued in OR
Practice address
2911 SE Village Lopp
Vancouver, WA 98683
Phone
(360) 601-3687
NPI assigned
Jan 6, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2025

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 PA228046 OR Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

2911 SE Village Lopp
Vancouver, WA 98683

Mailing address

3505 NW 129TH St
Vancouver, WA 98685-2267

Other practice location 1

450 N Graham St
Portland, OR 97227-1682
Phone (503) 413-4488

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
I20260102001883 OR Practitioner - Physician Assistant 6709372360 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Clinics LLCGroup PAC ID 0244144004, 714 clinicians

Practice addresses (Care Compare)

450 N Graham St
Portland, OR 97227-1682
Phone (503) 413-4488

Hospital & facility affiliations

  • Legacy Good Samaritan Medical Center Hospital, Portland, OR, CCN 380017

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PA228046ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Clinics LLC CurrentSince Dec 18, 2025 Accepting new patients

Locations

1960 NW 167th Pl
Ste 200
Beaverton, OR 97006
Phone (503) 413-4488

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

450 N Graham St
Portland, OR 97227
Phone (503) 413-4161

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 2

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": "1736121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766016000000",
    "number": "1992514780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3505 NW 129TH ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986852267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2911 SE VILLAGE LOPP",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "98683",
            "telephone_number": "360-601-3687"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "450 N Graham St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972271682",
            "country_code": "US",
            "telephone_number": "503-413-4488",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HANSON",
        "first_name": "BROOKS",
        "middle_name": "DOUGLAS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-01-06",
        "last_updated": "2025-12-18",
        "certification_date": "2025-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA228046",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.