Individual provider Active NPI

Veronika V Bibikova, PA-C

  • Physician Assistant
  • Tigard, OR
National Provider Identifier
1689055618
Registry record updated Sep 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA179429 Issued in OR
Practice address
18040 SW Lower Boones Ferry Rd Ste 100
Tigard, OR 97224-7259
Phone
(503) 216-0700
NPI assigned
Jun 16, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA179429 OR Primary

Addresses

Primary practice location

18040 SW Lower Boones Ferry Rd Ste 100
Tigard, OR 97224-7259

Mailing address

PO Box 3158
Portland, OR 97208-3158
Phone (503) 215-6494

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20170217001086 OR Practitioner - Physician Assistant 9335422328 Reassigns benefits to 3 organizations
I20200727002788 WA Practitioner - Physician Assistant 9335422328 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Oregon Health Sciences University School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10670 NE Cornell Rd
Hillsboro, OR 97124-9221

1321 NE 99TH Ave
Suite 100
Portland, OR 97220-9437
Phone (503) 215-9900

1321 NE 99TH Ave
Suite 200
Portland, OR 97220-9439
Phone (503) 215-4250

16770 SW Edy Rd
Suite 102
Sherwood, OR 97140-9679
Phone (503) 216-9600

200 S Hazel Dell Way
Canby, OR 97013-7829
Phone (203) 263-9500

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA179429ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Clinics LLC CurrentSince Jul 17, 2020 Accepting new patients
Icco, LLC CurrentSince Dec 1, 2017 Accepting new patients
Providence Health & Services Oregon CurrentSince Jun 17, 2024 Accepting new patients
Providence Health & Services - Oregon CurrentSince Jun 17, 2024 Accepting new patients
Providence Health & Services - Oregon Past Accepting new patients

Locations

200 S Hazel Dell Way
Canby, OR 97013
Phone (203) 263-9500

9290 SE Sunnybrook Blvd
Ste 210
Clackamas, OR 97015
Phone (503) 216-7960

598 E 13th Ave
Eugene, OR 97401
Phone (541) 636-3473

2850 SE Powell Valley Rd
Gresham, OR 97080
Phone (503) 666-5050

5050 NE Hoyt St
Ste 454
Portland, OR 97213
Phone (503) 215-6405

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

1321 NE 99th Ave
Ste 100
Portland, OR 97220
Phone (503) 215-4050

1321 NE 99th Ave
Ste 200
Portland, OR 97220
Phone (503) 215-4250

5050 NE Hoyt St
Ste 240
Portland, OR 97213
Phone (503) 215-6480

960 N 16th St
Ste 304
Springfield, OR 97477
Phone (541) 744-6172

18040 SW Lower Boones Ferry Rd
Ste 100
Tigard, OR 97224
Phone (503) 216-0624

12442 SW Scholls Ferry Rd
Ste 100
Tigard, OR 97223
Phone (503) 215-9900

305 SE Chkalov Dr
Ste 170
Vancouver, WA 98683
Phone (360) 799-3912

200 NE Mother Joseph Pl
Ste 410
Vancouver, WA 98664
Phone (503) 413-3580

Interoperability endpoints

  • Direct secure messaging: vbibikova587189@oc.providencedirect.org
  • Direct secure messaging: vbibikov@yourcarecommunity.org

Organizations & group practices 7

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 2

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": "1434412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727654400000",
    "number": "1689055618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "503-215-6494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18040 SW LOWER BOONES FERRY RD STE 100",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247259",
            "telephone_number": "503-216-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BIBIKOVA",
        "first_name": "VERONIKA",
        "middle_name": "V",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-16",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA179429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tigard, OR

Sources for this page

Verify at the official NPI Registry.