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GRACE LAKE
NPI 1124752233
Physician Assistant in Newport, OR

Active since July 13, 2022PECOS Enrolled
930 SW ABBEY ST, NEWPORT, OR 97365(541) 265-2244 Get Directions Write a Review

NPPES record last updated: November 8, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Nov 8, 2024, Sep 17, 2024, Aug 19, 2022 and 1 more (4 updates tracked since 2022).

About Grace Lake NPPES

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

GRACE LAKE (NPI 1124752233) is an individual physician assistant in Newport, Oregon, licensed in Oregon (PA221993) and active in the NPI registry since July 2022. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1124752233
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameGRACE LAKE
Location Address930 SW ABBEY STNewport, OR 97365-4820
Mailing Address930 Sw Abbey StNewport, OR 97365-4820
Phone(541) 265-2244
Sole ProprietorNo
Enumeration DateJuly 13, 2022
Last NPPES UpdateNovember 8, 20244 updates tracked since enumeration
NPPES CertifiedNovember 8, 2024
✔ NPI 1124752233 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 · PA221993
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.
930 SW ABBEY ST, Newport, OR 97365
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Grace Lake is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 97365 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
$84.82 typical visit price
range $54.96 – $166.64
Typical copayment $21.20 (range $13.74 – $41.66)
Most-billed visit code 99203
Established Patient
$68.64 typical visit price
range $17.68 – $136.19
Typical copayment $17.16 (range $4.42 – $34.04)
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.

SAMARITAN PACIFIC HEALTH SERVICES INC
Pharmacy (Institutional Pharmacy)
930 SW ABBEY ST
NEWPORT, OR 97365
Lincoln County (541) 574-4840
DEBRA PANKIEWICZ MD
Internal Medicine
930 SW ABBEY ST
NEWPORT, OR 97365
Lincoln County (541) 265-2244
KAREN G. KOZICK RD, CDE
Nutritionist (Nutrition, Education)
930 SW ABBEY ST
NEWPORT, OR 97365
Lincoln County (541) 574-1815
CODY SHANE ALLISON BS, ACSM-CEP
Clinical Exercise Physiologist
930 SW ABBEY ST
NEWPORT, OR 97365
Lincoln County (541) 574-4856
JEAN M FREDRICKSON LCSW
Social Worker (Clinical)
930 SW ABBEY ST
NEWPORT, OR 97365
Lincoln County (541) 574-1811
MR. RICHARD KASEY CRAVEN CSFA
Technician/Technologist
930 SW ABBEY ST
NEWPORT, OR 97365
Lincoln County (541) 574-4972
SAMARITAN PACIFIC HEALTH SERVICES INC
Medicare Defined Swing Bed Unit
930 SW ABBEY ST
NEWPORT, OR 97365
Lincoln County (541) 265-2244
TYLER R SCHULZ DO
Internal Medicine
930 SW ABBEY ST
NEWPORT, OR 97365
Lincoln County (541) 265-2244

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Grace Lake's NPI number?

The NPI number for Grace Lake is 1124752233. It was assigned to this individual provider in the NPPES registry on July 13, 2022.

Where is Grace Lake located?

Grace Lake practices at 930 SW Abbey St, Newport, OR 97365. The listed phone number is (541) 265-2244.

What is Grace Lake's specialty?

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

Is Grace Lake enrolled in Medicare?

Yes. Grace Lake is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Grace Lake was last updated on November 8, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 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.