Individual provider Active NPI

Nicole Marie Davis, D.O.

  • Anesthesiology Physician
  • Portland, OR
National Provider Identifier
1508251364
Registry record updated Oct 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
DO198351 Issued in OR
Practice address
707 SW Washington St Ste 700
Portland, OR 97205-3523
Phone
(503) 299-9906
Fax
(503) 225-9002
NPI assigned
Mar 30, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 266174 MA
Anesthesiology Physician 207L00000X DO198351 OR Primary

Addresses

Primary practice location

707 SW Washington St Ste 700
Portland, OR 97205-3523

Mailing address

PO Box 35147
#1801
Seatlle, WA 98124-5147

Other practice location 1

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone (503) 494-7641

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200731001436 OR Practitioner - Anesthesiology 9739481631 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Arizona College of Osteopathic Medicine Mid Western University, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hospitalist Medicine Physicians of Washington - TCSGroup PAC ID 6800240102, 197 clinicians

Practice addresses (Care Compare)

4805 NE Glisan St
Portland, OR 97213-2933
Phone (503) 215-1111

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
98.65
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
73.51 of 100Reported as group
Quality
68.84
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
266174MAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Salem Health CurrentSince Oct 2, 2023 Accepting new patients
Columbia Anesthesia Group P S Anesthesiology CurrentSince Jun 27, 2023 Accepting new patients
Hospitalist Medicine Physicians of Washington - TCS Anesthesiology CurrentSince Nov 1, 2023 Accepting new patients
Salem Health CurrentSince Oct 2, 2023 Accepting new patients
Oag Trauma Services LLC Anesthesiology PastSince Aug 23, 2020 Accepting new patients

Locations

1015 NW 22nd Ave
Portland, OR 97210
Phone (503) 413-7582

4805 NE Glisan St
Portland, OR 97213
Phone (503) 215-1111

9205 SW Barnes Rd
Portland, OR 97225
Phone (503) 216-1234

890 Oak St SE
Salem, OR 97301
Phone (503) 585-0830

665 Winter St SE
Salem, OR 97301
Phone (503) 370-5634

7300 SW Childs Rd
Ste A
Tigard, OR 97224
Phone (360) 828-5396

Organizations & group practices 5

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 1

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": "1427673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696982400000",
    "number": "1508251364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35147",
            "address_2": "#1801",
            "city": "SEATLLE",
            "state": "WA",
            "postal_code": "981245147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 SW WASHINGTON ST STE 700",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972053523",
            "telephone_number": "503-299-9906",
            "fax_number": "503-225-9002"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3181 SW Sam Jackson Park Rd",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972393011",
            "country_code": "US",
            "telephone_number": "503-494-7641",
            "fax_number": "503-494-4661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-30",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MA",
            "license": "266174",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OR",
            "license": "DO198351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.