NPIMap

Individual provider Active NPI

Nicole E. Parker, PA-C

  • Medical Physician Assistant
  • Portland, OR
National Provider Identifier
1669478210
Registry record updated May 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA00794 Issued in OR
Practice address
1040 NW 22ND Ave Ste 660
Portland, OR 97210-3083
Phone
(503) 413-7162
Fax
(503) 413-7148
NPI assigned
Jun 27, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA00794 OR Primary

Addresses

Primary practice location

1040 NW 22ND Ave Ste 660
Portland, OR 97210-3083

Mailing address

PO Box 3777
Portland, OR 97208-3777
Phone (503) 413-3900

Other identifiers 1

IdentifierTypeStateIssuer
227036MedicaidOR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060501000678 OR Practitioner - Physician Assistant 2365452620 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1996
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)

1015 NW 22ND Ave
Portland, OR 97210-3025
Phone (503) 413-7711

1015 Nw22Nd Ave
Suite 34
Portland, OR 97210-3025
Phone (503) 413-6376

1130 NW 22ND Ave
Suite 220
Portland, OR 97210-2969
Phone (503) 413-8988

19250 SW 65TH Ave
Suite 265
Tualatin, OR 97062-7747
Phone (503) 413-6862

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

Merit-based Incentive Payment System (MIPS)

Final score
89.44 of 100Reported as group
Quality
87
Promoting interoperability
100
Improvement activities
40
Cost
73.18

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA00794ORMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Emanuel Hospital & Health Center CurrentSince Apr 21, 2016 Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Apr 21, 2016 Accepting new patients
Legacy Clinics LLC CurrentSince Mar 1, 2016 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince Apr 21, 2016 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince Apr 21, 2016 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center Past Accepting new patients

Locations

1960 NW 167th Pl
Ste 205
Beaverton, OR 97006
Phone (503) 629-7500

2725 SW Cedar Hills Blvd
Ste 250
Beaverton, OR 97005
Phone (503) 413-4060

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

1040 NW 22nd Ave
Ste 660
Portland, OR 97210
Phone (503) 692-0405

1040 NW 22nd Ave
Ste 630
Portland, OR 97210
Phone (503) 796-2743

1200 NW 23rd Ave
Portland, OR 97210
Phone (503) 413-7074

1130 NW 22nd Ave
Ste 400
Portland, OR 97210
Phone (503) 413-6555

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

501 N Graham St
Ste 200
Portland, OR 97227
Phone (503) 413-4488

475 S Columbia River Hwy
Ste 100
Saint Helens, OR 97051
Phone (503) 229-8455

19250 SW 65th Ave
Tualatin, OR 97062
Phone (503) 691-6582

Interoperability endpoints

  • Direct secure messaging: nparker14178@direct.lhs.org

Organizations & group practices 8

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 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1119830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463616000000",
    "number": "1669478210",
    "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",
            "fax_number": "503-413-3710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 NW 22ND AVE STE 660",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972103083",
            "telephone_number": "503-413-7162",
            "fax_number": "503-413-7148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARKER",
        "first_name": "NICOLE",
        "middle_name": "E.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-27",
        "last_updated": "2016-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA00794",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "227036",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.