Individual provider Active NPI

Scott D Sonek, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Portland, OR
National Provider Identifier
1164688156
Registry record updated Aug 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
200850087NP Issued in OR
Practice address
4805 NE Glisan St
3E
Portland, OR 97213-2933
Phone
(503) 215-7669
NPI assigned
Jul 30, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 200850087NP OR Primary
Nurse Practitioner 363L00000X 200850087NP OR

Addresses

Primary practice location

4805 NE Glisan St
3E
Portland, OR 97213-2933

Mailing address

PO Box 3158
Portland, OR 97208-3158

Other identifiers 2

IdentifierTypeStateIssuer
026205MedicaidOR
500628066MedicaidOR

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
I20090414000714 OR Practitioner - Nurse Practitioner 2163579897 Reassigns benefits to 1 organization
I20130313000324 WA Practitioner - Nurse Practitioner 2163579897 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
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

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
200850087NPORMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Clinics LLC CurrentSince Feb 24, 2009 Accepting new patients
Legacy Salmon Creek Hospital CurrentSince Jan 26, 2013 Accepting new patients
Legacy Salmon Creek Hospital CurrentSince Jan 26, 2013 Accepting new patients

Locations

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

2211 NE 139th St
Vancouver, WA 98686
Phone (360) 397-1985

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 and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1217376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376956800000",
    "number": "1164688156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4805 NE GLISAN ST",
            "address_2": "3E",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132933",
            "telephone_number": "503-215-7669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONEK",
        "first_name": "SCOTT",
        "middle_name": "D",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-30",
        "last_updated": "2013-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "200850087NP",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OR",
            "license": "200850087NP",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "026205",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500628066",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.