Unknown Individual – Physician Assistant, NPI 1801802707

Unknown Individual is a healthcare provider. based in Portland, Oregon. specializing in Physician Assistant. They hold a License No. PA10001497 (WA). The NPI Number for Unknown Individual is 1801802707

Main info

Organization
Inactive
39 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1801802707
Phone
Not provided
Address
PO BOX 3360
Deactivation Date
21 July 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3607937230
Graduation Year
1987 (39 years ago)
PAC ID
7517002389
Group Practice PAC ID
6709782600
Professional Enrollment ID
I20100729000755
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 3360, Southwest 87th Avenue, Raleigh West, Portland, Metro, Washington County, Oregon, 97225, United States

    PORTLAND, OR 972083360

    Phone:

    Type: Mailing

  • 931, South Market Boulevard, Chehalis, Lewis County, Washington, 98532, United States

    CHEHALIS, WA 985323423

    Phone: (360) 767-6300

    Fax: (360) 767-6320

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 97208)

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Provider's Procedures

Unknown Individual performs procedures in Physician Assistant. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
PHYSICIAN ASSISTANTWA51798Ultrasound measurement of bladder capacity after voiding6654

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 6709782600View full group profile
NameSpecialtyState
H E M A T O L O G Y/ O N C O L O G YWA
Gynecological Oncology, Obstetrics/GynecologyCA
-OR
Certified Nurse Midwife (Cnm)WA
O B S T E T R I C S/ G Y N E C O L O G YWA
-WA
Physician AssistantWA
Mental Health CounselorWA
-WA
O B S T E T R I C S/ G Y N E C O L O G YWA

Reviews

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Frequently asked questions

Does Unknown Individual have a public NPI I can cite?
Public records show Unknown Individual under NPI 1801802707.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
Which specialty label fits Unknown Individual?
NPPES ties Unknown Individual to Physician Assistant in the taxonomy section. Clinical services aligned with this taxonomy classification.
What geographic area is tied to Unknown Individual?
Unknown Individual is associated with Portland, Oregon in the same public data insurers reference.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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