NPIMap

Individual provider Active NPI

Maryika Gibson, NP

  • Family Nurse Practitioner
  • Camas, WA
National Provider Identifier
1427471275
Registry record updated Aug 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP60401486 Issued in WA
Practice address
1700 NE Everett St
Camas, WA 98607-1224
Phone
(360) 216-1536
NPI assigned
Jan 30, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 29, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 20139195NP OR
Family Nurse Practitioner 363LF0000X AP60401486 WA Primary

Addresses

Primary practice location

1700 NE Everett St
Camas, WA 98607-1224

Mailing address

1700 NE Everett St
Camas, WA 98607-1224
Phone (360) 216-1536

Other practice location 1

505 NE 87th Ave Ste 460
Vancouver, WA 98664-1965
Phone (360) 514-7771

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160822001699 OR Practitioner - Nurse Practitioner 1850686460 Reassigns benefits to 1 organization
I20191014003363 WA Practitioner - Nurse Practitioner 1850686460 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Legacy Salmon Creek HospitalGroup PAC ID 0446295711, 309 clinicians
Legacy Clinics LLCGroup PAC ID 0244144004, 714 clinicians

Practice addresses (Care Compare)

2121 NE 139TH St
Vancouver, WA 98686-2316

2211 NE 139TH St
Vancouver, WA 98686-2742
Phone 3604871000360487

2801 N Gantenbein Ave
Portland, OR 97227-1623
Phone (503) 413-2200

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
20139195NPORMDFamily Nurse Practitioner
AP60401486WAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Salmon Creek Hospital CurrentSince Aug 30, 2019 Accepting new patients
Legacy Salmon Creek Hospital CurrentSince Aug 30, 2019 Accepting new patients
Legacy Clinics LLC CurrentSince Jun 11, 2016 Accepting new patients

Locations

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

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

1040 NW 22nd Ave
Ste 420
Portland, OR 97210
Phone (503) 229-7566

501 N Graham St
Ste 445
Portland, OR 97227
Phone (503) 284-5220

19260 SW 65th Ave
Ste 280
Tualatin, OR 97062
Phone (503) 413-6166

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

2121 NE 139th St
Ste 205
Vancouver, WA 98686
Phone (360) 487-4707

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 9

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": "1391040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661731200000",
    "number": "1427471275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 NE EVERETT ST",
            "city": "CAMAS",
            "state": "WA",
            "postal_code": "986071224",
            "telephone_number": "360-216-1536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 NE EVERETT ST",
            "city": "CAMAS",
            "state": "WA",
            "postal_code": "986071224",
            "telephone_number": "360-216-1536"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "505 NE 87th Ave Ste 460",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986641965",
            "country_code": "US",
            "telephone_number": "360-514-7771",
            "fax_number": "360-514-7769",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "MARYIKA",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-01-30",
        "last_updated": "2022-08-29",
        "certification_date": "2022-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "20139195NP",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP60401486",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Camas, WA

Sources for this page

Verify at the official NPI Registry.