Nicolle Asencio
Individual provider Active NPI Family Nurse Practitioner · Portland, OR
NPI 1225753692 · NPPES record last updated Nov 15, 2024
Key facts
- NPI
- 1225753692
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 10031838 (OR)
- Practice address
- 19500 SE Stark St
Portland, OR 97233-5757 - Phone
- (800) 813-2000
- NPI assigned
- Oct 7, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- The Wallace Medical Concern
Practice addresses (Care Compare)
18633 SE Stark St
Suite 401
Portland, OR 97233-5468
Phone (503) 489-1760
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250327001995 | OR | Practitioner - Nurse Practitioner | 8921521246 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 10031838 | OR | Yes |
Addresses
Primary practice location
19500 SE Stark St
Portland, OR 97233-5757
Mailing address
8703 N Chase Ave
Portland, OR 97217
Phone (503) 975-6187
Other providers in Portland, OR
- Ascension Medical Group LLC
- Megan Anne Aschenbrenner
- Ashlyn Ilene Ascuena-Mercil
- Lorri Asder
- Selam Habte Asefaw
- Meseret Mehretab Asfeha
- Kristen A Ash
- Laurel Taylor Ash
- Loren Elise Ash
- Zachary L Ash
All providers in Portland, OR · Family Nurse Practitioner in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 15, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.