Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Samuel Lopez, PA-C

Individual provider Physician Assistant · NPI 1114167756

Mr. Samuel Lopez, PA-C is a Physician Assistant in Vancouver, Washington. Qualified in 2010, 16 years ago. Practices with Kaiser Foundation Health Plan of the Northwest, a 1,811-clinician group and accepts Medicare assignment. Licensed in Colorado and Oregon.

Years since qualifying
16
Licensed in
CO, OR
In the registry since
2009
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

203 SE Park Plaza Dr Ste 140
Vancouver, WA 98684-5887
Phone: (800) 813-2000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence PAL-3102 (CO)
Physician Assistant Taxonomy 363A00000X · Licence PA156712 (OR)

Record details

NPI number1114167756
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedFebruary 23, 2009
Last updated in NPPESMarch 6, 2022
Certification dateMarch 6, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2010 (16 years in practice)
Group practice Kaiser Foundation Health Plan Of The Northwest — 1811 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

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