Individual provider Active NPI

Elizabeth M Decker

  • Family Nurse Practitioner
  • Louisville, KY
National Provider Identifier
1114688439
Registry record updated Oct 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
10016062 Issued in OR
Practice address
10490 Shelbyville Rd
Louisville, KY 40223-3120
Phone
(502) 245-8853
NPI assigned
Jan 8, 2022
Last updated
Oct 20, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 3017163 KY
Family Nurse Practitioner 363LF0000X 10016062 OR Primary

Addresses

Primary practice location

10490 Shelbyville Rd
Louisville, KY 40223-3120

Mailing address

10490 Shelbyville Rd
Louisville, KY 40223-3120

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20231026003934 OR Practitioner - Nurse Practitioner 6103210554 Reassigns benefits to 1 organization
I20250408001869 WA Practitioner - Nurse Practitioner 6103210554 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
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)

13009 NE Hwy 99
Suite 109
Vancouver, WA 98686-2307
Phone (360) 667-5840

2850 SE Powell Valley Rd
Gresham, OR 97080-1494
Phone (503) 666-5050

305 SE Chkalov Dr
Suite 170
Vancouver, WA 98683-5263
Phone (360) 799-3912

3425 SE 192ND Ave
Suite 106
Vancouver, WA 98683-1440
Phone (360) 205-2960

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
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
3017163KYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Clinics LLC CurrentSince Oct 20, 2023 Accepting new patients
Legacy Salmon Creek Hospital Past Accepting new patients
Legacy Clinics LLC PastSince Oct 20, 2023 Accepting new patients

Locations

2870 SW Cedar Hills Blvd
Beaverton, OR 97005
Phone (503) 646-9222

22262 NE Glisan St
Gresham, OR 97030
Phone (503) 489-2024

2850 SE Powell Valley Rd
Gresham, OR 97080
Phone (503) 666-5050

9361 SE 82nd Ave
Happy Valley, OR 97086
Phone (503) 457-4301

3 Monroe Pkwy
Ste X
Lake Oswego, OR 97035
Phone (503) 679-3748

1900 McLoughlin Blvd
Ste 67
Oregon City, OR 97045

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

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

4800 SW 76th Ave
Portland, OR 97225
Phone (971) 808-0665

21430 SW Langer Farms Pkwy
Ste 158
Sherwood, OR 97140
Phone (971) 808-0655

21900 Willamette Dr
Ste 209
West Linn, OR 97068
Phone (971) 274-0038

200 NE Mother Joseph Pl
Ste 410
Vancouver, WA 98664
Phone (503) 413-3580

305 SE Chkalov Dr
Ste 170
Vancouver, WA 98683
Phone (360) 799-3912

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1641600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697760000000",
    "number": "1114688439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10490 SHELBYVILLE RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402233120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10490 SHELBYVILLE RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402233120",
            "telephone_number": "502-245-8853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECKER",
        "first_name": "ELIZABETH",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-08",
        "last_updated": "2023-10-20",
        "certification_date": "2023-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3017163",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "10016062",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.