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  7. NPI Record 1710254743

SOWMYA MARIAM JOHN PA-C
Complete NPI Record 1710254743
Physician Assistant - Surgical in Portland, OR

NPI Status: Active since November 18, 2011

Contact Information

2222 NW LOVEJOY ST STE 622
PORTLAND, OR
ZIP 97210
Phone: (503) 229-8455
Fax: (503) 229-7028

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Middle Name
  6. Provider Credential Text
  7. Provider Other Last Name
  8. Provider Other First Name
  9. Provider Other Middle Name
  10. Provider Other Credential Text
  11. Provider Other Last Name Type Code
  12. Provider First Line Business Mailing Address
  13. Provider Business Mailing Address City Name
  14. Provider Business Mailing Address State Name
  15. Provider Business Mailing Address Postal Code
  16. Provider Business Mailing Address Country Code If outside U S
  17. Provider Business Mailing Address Telephone Number
  18. Provider Business Mailing Address Fax Number
  19. Provider First Line Business Practice Location Address
  20. Provider Business Practice Location Address City Name
  21. Provider Business Practice Location Address State Name
  22. Provider Business Practice Location Address Postal Code
  23. Provider Business Practice Location Address Country Code If outside U S
  24. Provider Business Practice Location Address Telephone Number
  25. Provider Business Practice Location Address Fax Number
  26. Provider Enumeration Date
  27. Last Update Date
  28. Provider Gender Code
  29. Healthcare Provider Taxonomy Code 1
  30. Provider License Number State Code 1
  31. Healthcare Provider Primary Taxonomy Switch 1
  32. Healthcare Provider Taxonomy Code 2
  33. Provider License Number 2
  34. Provider License Number State Code 2
  35. Healthcare Provider Primary Taxonomy Switch 2
  36. Other Provider Identifier 1
  37. Other Provider Identifier Type Code 1
  38. Other Provider Identifier State 1
  39. Other Provider Identifier 2
  40. Other Provider Identifier Type Code 2
  41. Other Provider Identifier State 2
  42. Is Sole Proprietor
  43. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1710254743. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1710254743
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 1
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: SOWMYA
The first name of the provider, if the provider is an individual.
Provider Middle Name: MARIAM
The middle name of the provider, if the provider is an individual.
Provider Credential Text: PA-C
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider Other Last Name: OOMMEN
Other last name by which the provider being identified is or has been known.
Provider Other First Name: SOWMYA
Other first name by which the provider being identified is or has been known (if an individual). This may be the same as the ‘‘Provider first name’’ if the provider is or has been known by a different last name only.
Provider Other Middle Name: MARIAM
Other middle name by which the provider being identified is or has been known (if an individual). This may be the same as the ‘‘Provider middle name’’ if the provider is or has been known by a different last name only.
Provider Other Credential Text: PA-C
The other abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider Other Last Name Type Code: 1
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address: 541 NE 20TH AVE STE 225
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: PORTLAND
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: OR
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 972322895
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 5039632801
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 5039632825
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 2222 NW LOVEJOY ST STE 622
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: PORTLAND
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: OR
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 972105104
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 5032298455
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 5032297028
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 11/18/2011
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 11/26/2024
The date that a record was last updated or changed.
Provider Gender Code: F
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 363A00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number State Code 1: TX
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 363AS0400X
Provider License Number 2: PA213049
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 2: OR
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2: Y
Other Provider Identifier 1: 2257109
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: WA
Other Provider Identifier 2: 500825015
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: OR
Is Sole Proprietor: N
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
NPI Certification Date: 11/26/2024