MR. ANDREW SURYANATA MATTSON PA-C
NPI 1043102825
Physician Assistant in Portland, OR

Q: What is Andrew Mattson's NPI number?

The NPI number for Andrew Mattson is 1043102825. It was assigned to this individual provider in the NPPES registry on July 16, 2025.

Q: What is Andrew Mattson's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Andrew Mattson was last updated on December 3, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 16, 2025PECOS EnrolledAccepts Medicare Assignment

11782 SW BARNES RD STE 300, PORTLAND, OR 97225(503) 214-5200(503) 906-6613 Get Directions Write a Review

NPPES record last updated: December 3, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Mr. Andrew Suryanata Mattson Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. ANDREW SURYANATA MATTSON PA-C (NPI 1043102825) is an individual physician assistant in Portland, Oregon, licensed in Oregon (PA227790) and active in the NPI registry since July 2025. He is enrolled in Medicare PECOS, is affiliated with Providence St Vincent Medical Center, and maintains a secondary practice location in Beaverton.

NPPES Registry Identity

NPI1043102825

Entity TypeIndividualMale

Primary Taxonomy363A00000X

Provider Legal NameMR. ANDREW SURYANATA MATTSONCredential: PA-C

Location Address11782 SW BARNES RD STE 300Portland, OR 97225-5933

Mailing Address11782 Sw Barnes Rd Ste 300Portland, OR 97225-5933 · (503) 214-5200 · Fax (503) 906-6613

Phone(503) 214-5200

Fax(503) 906-6613

Sole ProprietorYes

Medical School CMSOtherGraduated 2025

Enumeration DateJuly 16, 2025

Last NPPES UpdateDecember 3, 2025

NPPES CertifiedDecember 3, 2025

✔ NPI 1043102825 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in OR · PA227790

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

11782 SW BARNES RD STE 300, Portland, OR 97225

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Secondary Practice Location 1

Location 114795 SW Murray Scholls DrBeaverton, OR 97007-9713 · Phone (503) 214-5200

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mr. Andrew Suryanata Mattson Pa-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2567956899

PECOS Enrollment IDI20251212003591

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Providence St Vincent Medical Center

Acute Care Hospitals · Portland, OR

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number380004

Location9205 SW Barnes RoadPortland, OR 97225 · Washington County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 97225 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$90.51 typical visit price

range $58.99 – $176.88

Typical copayment $22.62 (range $14.74 – $44.22)

Most-billed visit code 99203

Established Patient

$73.28 typical visit price

range $19.32 – $144.79

Typical copayment $18.32 (range $4.83 – $36.19)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ROBERT BRIAN BETTENCOURT MD

Family Medicine