MADISON MARIE MABRY PAC NPI 1194348219

NPI Information

  • NPI: 1194348219
  • Provider Name: MADISON MARIE MABRY, PAC
  • Classification: Physician Assistant - 363AS0400X
  • Specialization: Surgical
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 5050 NE HOYT ST STE 138
    PORTLAND, OR
    ZIP 97213
  • Phone: (503) 238-1061

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NPI Details

Madison Marie Mabry, PAC is a surgical physician assistant in Portland, OR with 4 years of experience. Madison Marie Mabry, PAC NPI is 1194348219. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

5050 NE HOYT ST STE 138
PORTLAND, OR
ZIP 97213-955
Phone: (503) 238-1061
Fax: (503) 238-0841

The NPI 1194348219 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Knee replacement (HCPCS:NAN06)

The enumeration date for this NPI number is 5/22/2020 and was last updated on 11/5/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363AS0400XPhysician AssistantSurgicalPA213704OREGONYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1500812454MEDICAIDOREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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