Carey Wickham

Primary specialty

Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X

License

MD212636 Issued in OR

Practice address

4805 NE Glisan St Ste 6N60
Portland, OR 97213-2933

Phone

(503) 281-0561

Fax

(503) 416-7377

NPI assigned

Feb 20, 2017

Last updated

Apr 21, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 1

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: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Colorectal Surgery (Proctology)

Education

George Washington University School of Medicine, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Oregon Clinic, PCGroup PAC ID 2860390408, 353 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Portland Medical Center Hospital, Portland, OR, CCN 380061
• Legacy Good Samaritan Medical Center Hospital, Portland, OR, CCN 380017
• Providence St Vincent Medical Center Hospital, Portland, OR, CCN 380004

Merit-based Incentive Payment System (MIPS)

Final score

98.3 of 100Reported as group

Quality

93.8

Promoting interoperability

100

Improvement activities

40

Cost

87.81

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cwickham973138@direct.lhs.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Oregon Clinic PC

  • Specialist
  • Portland, OR
  • NPI 1265417174

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• Northwest Minimally Invasive Surgery, LLC

  • Surgery Physician
  • Portland, OR
  • NPI 1386168029

  Multi-Specialty, WA

  Medicare reassignment NPD
• The Oregon Clinic, PC

  • Durable Medical Equipment & Medical Supplies
  • Portland, OR
  • NPI 1346105129
  NPD
• Peacehealth

  dba PeaceHealth Southwest Medical Center

  • General Acute Care Hospital
  • Vancouver, WA
  • NPI 1134178999

  Multi-Specialty

  NPD (past)

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

• Legacy Good Samaritan Hospital and Medical Center

  dba Legacy Good Samaritan Providers

  • 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
• Providence Health & Services - Oregon

  dba Providence Portland Medical Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1003991845
  Care Compare affiliation
• Providence Health & Services - Oregon

  dba Providence St Vincent Medical Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1114015971
  Care Compare affiliation
• Providence Health & Services - Oregon

  • Case Manager/Care Coordinator
  • Portland, OR
  • NPI 1891822995

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1487548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776729600000",
    "number": "1750820007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 NE 20TH AVE STE 225",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322895",
            "telephone_number": "503-963-2801",
            "fax_number": "503-963-2825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4805 NE GLISAN ST STE 6N60",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132933",
            "telephone_number": "503-281-0561",
            "fax_number": "503-416-7377"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11000 SW Stratus St Ste 205",
            "address_purpose": "LOCATION",
            "city": "Beaverton",
            "state": "OR",
            "postal_code": "970087104",
            "country_code": "US",
            "telephone_number": "503-281-0561",
            "fax_number": "503-416-7377",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WICKHAM",
        "first_name": "CAREY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-02-20",
        "last_updated": "2026-04-21",
        "certification_date": "2026-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "145897",
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "OR",
            "license": "MD212636",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2232453",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500810902",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cc_otoc_cas_front_desk_pool12223192@oc.providencedirect.org",
            "affiliation": "Y",
            "affiliationName": "The Oregon Clinic PC",
            "address_1": "4805 NE Glisan St Ste 6N60",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972132933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Promporn Paula Wichienkuer, MD
• Jessica Wick, LMT 27215
• Judy L Wick, RN
• Kyra Jo Wick, M.S., CFY-SLP
• Shelby Wick
• Michelle Antoinette Wickliff, T/CHW,DOULA,CRM,HCW
• Laura Marie Wickline, PMHNP
• Natalie Rose Wickline, DDS
• Roger A Wicklund, M.D.
• Jacob Wicks

• Colon & Rectal Surgery Physician in Portland, OR
• Providers in Portland, OR by specialty
• Colon & Rectal Surgery Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2026; 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.