NPIMap

Individual provider Active NPI

Nicolette Michelle Bottesini, DO

  • Internal Medicine Physician
  • Portland, OR
National Provider Identifier
1114554037
Registry record updated Jun 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
DO215871 Issued in OR
Practice address
1200 NW 23Rd Ave
Portland, OR 97210-2906
Phone
(503) 413-7074
Fax
(503) 413-6892
NPI assigned
Mar 23, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 13, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X DO215871 OR Primary

Addresses

Primary practice location

1200 NW 23Rd Ave
Portland, OR 97210-2906

Mailing address

1200 NW 23Rd Ave
Portland, OR 97210-2906
Phone (503) 413-7074

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230626001844 OR Practitioner - Internal Medicine 0244652261 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of New England, College of Osteo Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Clinics LLCGroup PAC ID 0244144004, 714 clinicians

Practice addresses (Care Compare)

1015 NW 22ND Ave
Portland, OR 97210-3025
Phone (503) 413-7711

1015 Nw22Nd Ave
Suite 34
Portland, OR 97210-3025
Phone (503) 413-6376

1130 NW 22ND Ave
Suite 220
Portland, OR 97210-2969
Phone (503) 413-8988

2801 N Gantenbein Ave
Portland, OR 97227-1623
Phone (503) 413-1122

Hospital & facility affiliations

  • Legacy Emanuel Medical Center Hospital, Portland, OR, CCN 380007
  • Legacy Good Samaritan Medical Center Hospital, Portland, OR, CCN 380017

Merit-based Incentive Payment System (MIPS)

Final score
94.62 of 100Reported as apm
Quality
77.21
Promoting interoperability
99.06
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
DO215871ORMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince Jun 13, 2023 Accepting new patients
Legacy Emanuel Hospital & Health Center Current Accepting new patients
Legacy Good Samaritan Hospital and Medical Center Current Accepting new patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince Jun 13, 2023 Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Jun 13, 2023 Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Jun 13, 2023 Accepting new patients
Legacy Clinics LLC Internal Medicine CurrentSince Sep 12, 2023 Accepting new patients

Locations

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

1919 NW Lovejoy St
Portland, OR 97209
Phone (503) 415-5600

1200 NW 23rd Ave
Portland, OR 97210
Phone (503) 413-7074

2800 N Vancouver Ave
Ste 230
Portland, OR 97227
Phone (503) 413-2901

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1584921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686614400000",
    "number": "1114554037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 NW 23RD AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102906",
            "telephone_number": "503-413-7074",
            "fax_number": "503-413-6892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 NW 23RD AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102906",
            "telephone_number": "503-413-7074",
            "fax_number": "503-413-6892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOTTESINI",
        "first_name": "NICOLETTE",
        "middle_name": "MICHELLE",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-23",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "DO215871",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.