IndividualActive
Roberta Vandentop, PHYSICIAN ASSISTANT
NPI 1124109889 · Medical Physician Assistant · Portland, OR
Provider details
- NPI number
- 1124109889
- Entity type
- Individual
- Primary specialty
- Medical Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- PHYSICIAN ASSISTANT
- Sex
- Female
- Sole proprietor
- Yes
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Profile Score
Detailed profile(84/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
83% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1815 Sw Marlow Ave
Ste 110
Portland, OR 97225-5185
Phone: (503) 296-0918
Fax: (503) 296-6158
Street-level locationGet directions
Mailing address
14807 Nw Applegate Ln
Portland, OR 97229-1899
Registry dates
- Enumerated
- 2006-10-18
- Last updated
- 2007-07-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.