Stacy Marie Rudy, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA179627 Issued in OR

Practice address

6640 SW Redwood LN
Portland, OR 97224-7187

Phone

(503) 620-7358

NPI assigned

Feb 27, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Stacy Marie Abraham Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR

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 1

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Portland ClinicGroup PAC ID 8224942867, 93 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence St Vincent Medical Center Hospital, Portland, OR, CCN 380004

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: srudy32081@theportlandclinic.gardenplot.direct-ci.com
• Direct secure messaging: srudy7667@direct.theportlandclinic.net

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.

• Portland Clinic

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1558379099
  Medicare reassignment Care Compare group
• The Portland Clinic Laboratory

  • Clinical Medical Laboratory
  • Portland, OR
  • NPI 1053448795
  NPD

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

• Providence Health & Services - Oregon

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1114015971
  Care Compare affiliation

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

{
    "created_epoch": "1424995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605657600000",
    "number": "1154713188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 SW 13TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972051902",
            "telephone_number": "503-221-0161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6640 SW REDWOOD LN",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972247187",
            "telephone_number": "503-620-7358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDY",
        "first_name": "STACY",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-27",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA179627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "srudy7667@direct.theportlandclinic.net",
            "affiliation": "N",
            "address_1": "6640 SW Redwood Ln",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972247187",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "STACY",
            "last_name": "ABRAHAM",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alexander Rudnitski, DMD
• Elyse Rudolph
• Sally Foster Rudolph, MA
• Charles Craig Rudy
• Megan Rudy, MSW
• Martha Rudzinski, LMT
• Marijean Suzanne Rue, LMT
• Gloria Rueda Alvarez
• Jose F. Rueda, MD
• Elizabeth J. Ruegg, PHYSICAL THERAPIST

• Physician Assistant in Portland, OR
• Providers in Portland, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.