Nicky Callicotte

Primary specialty

Social WorkerTaxonomy code 104100000X

License

L11089 Issued in OR

Practice address

36860 Industrial Way
Sandy, OR 97055-7371

Phone

(503) 826-0206

NPI assigned

Sep 8, 2008

Last updated

Jun 6, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Nicky McLean Other name

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2014

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)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Legacy Clinics LLC

  • Clinic/Center
  • Portland, OR
  • NPI 1902827272
  Medicare reassignment Care Compare group NPD
• Legacy Clinics LLC

  dba Legacy Medical Group Firwood

  • Rural Health Clinic/Center
  • Sandy, OR
  • NPI 1730472192
  NPD

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

{
    "created_epoch": "1220832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717632000000",
    "number": "1205084845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3777",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083777",
            "telephone_number": "503-413-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36860 INDUSTRIAL WAY",
            "city": "SANDY",
            "state": "OR",
            "postal_code": "970557371",
            "telephone_number": "503-826-0206"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "847 NE 19th Ave",
            "address_2": "Ste. 100",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972322684",
            "country_code": "US",
            "telephone_number": "503-552-6203",
            "fax_number": "503-552-6208",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CALLICOTTE",
        "first_name": "NICKY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-09-08",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OR",
            "license": "L11089",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICKY",
            "last_name": "MCLEAN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jamie Brown, PA-C
• Bruce a. Biermann D.M.D.,P.C.
• Madisen Bunch, RDH
• Sara A Buse, FNP
• Elizabeth Busetto, ND, DC, IBCLC
• Andrea Calvert, ED.S., M.A.
• Carl E. Swarts (Pioneer Chiropractic)
• Cascade Specialized Nursing, LLC.
• Catherine Saul, OD, LLC
• Michael J Cha, MD

• Social Worker in Sandy, OR
• Providers in Sandy, OR by specialty
• Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2024; 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.