Marivic Rustia

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

AP139794 Issued in TX

Practice address

2222 NW Lovejoy St Ste 411
Portland, OR 97210-5102

Phone

(503) 413-5598

NPI assigned

Nov 21, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Legacy Clinics LLCGroup PAC ID 0244144004, 714 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Legacy Good Samaritan Medical Center Hospital, Portland, OR, CCN 380017
• Legacy Meridian Park Medical Center Hospital, Tualatin, OR, CCN 380089
• Legacy Mount Hood Medical Center Hospital, Gresham, OR, CCN 380025

Merit-based Incentive Payment System (MIPS)

Final score

94.62 of 100Reported as apm

Quality

77.21

Promoting interoperability

99.06

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mrustia628274@direct.lhs.org
• Direct secure messaging: mrustia108120@direct.phhs.org

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.

• Legacy Clinics LLC

  • Clinic/Center
  • Portland, OR
  • NPI 1902827272
  Medicare reassignment Care Compare group NPD
• Pacific Heart Associates, P.C.

  • Specialist
  • Portland, OR
  • NPI 1811028525
  NPD (past)
• Advanced Kidney Care PLLC

  • Nephrology Physician
  • Plano, TX
  • NPI 1205224268
  NPD (past)
• Legacy Salmon Creek Hospital

  • General Acute Care Hospital
  • Vancouver, WA
  • NPI 1700809829
  NPD (past)

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

• Legacy Good Samaritan Hospital and Medical Center

  • Clinic/Center
  • Portland, OR
  • NPI 1679597108

  Hospital

  Care Compare affiliation
• Legacy Good Samaritan Hospital and Medical Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1780608216
  Care Compare affiliation
• Legacy Meridian Park Hospital

  • General Acute Care Hospital
  • Tualatin, OR
  • NPI 1184647620
  Care Compare affiliation
• Legacy Mount Hood Medical Center

  • General Acute Care Hospital
  • Gresham, OR
  • NPI 1255354700
  Care Compare affiliation

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

{
    "created_epoch": "1542758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633996800000",
    "number": "1376012104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 SW HARRISON ST APT 11D",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972015387",
            "telephone_number": "682-240-5523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 NW LOVEJOY ST STE 411",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972105102",
            "telephone_number": "503-413-5598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSTIA",
        "first_name": "MARIVIC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-11-21",
        "last_updated": "2021-10-12",
        "certification_date": "2021-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "AP139794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haley Russo
• Larry Russock
• Bethany Russotto, PA-C
• Chloe Rust
• Randee L Rust, LMT
• Rustic Sage LLC
• Susan Rustvold, DMD
• Flavius Rusu
• Claire Levesque Rusunen, PSY.D.
• Rob Rusunen

• Acute Care Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Acute Care Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2021; 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.