Nicole Jene Fennimore, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

MD205498 Issued in OR

Practice address

10101 SE Main St Ste 3001
Portland, OR 97216-2458

Phone

(503) 261-4423

Fax

(503) 261-4424

NPI assigned

Mar 26, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Specialty

Obstetrics/Gynecology

Education

University of Wisconsin School of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Obhg Illinois SCGroup PAC ID 7810179702, 27 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• HSHS St Elizabeth'S Hospital Hospital, O Fallon, IL, CCN 140187

Merit-based Incentive Payment System (MIPS)

Final score

92 of 100Reported as group

Quality

84.7

Promoting interoperability

100

Improvement activities

40

Cost

79.21

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Obhg Illinois SC

  • Obstetrics & Gynecology Physician
  • Berwyn, IL
  • NPI 1700107216

  IL, Obstetrics & Gynecology

  Medicare reassignment Care Compare group NPD
• Shawnee Health Service and Development Corp

  • Federally Qualified Health Center (FQHC)
  • Carterville, IL
  • NPI 1639295314

  IL

  Medicare reassignment

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

• St Elizabeths Hospital of the Hospital Sisters of the Third Order

  • General Acute Care Hospital
  • O Fallon, IL
  • NPI 1629057302

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1553558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698019200000",
    "number": "1922569748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10101 SE MAIN ST STE 3001",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972162458",
            "telephone_number": "503-261-4423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10101 SE MAIN ST STE 3001",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972162458",
            "telephone_number": "503-261-4423",
            "fax_number": "503-261-4424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENNIMORE",
        "first_name": "NICOLE",
        "middle_name": "JENE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-26",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OR",
            "license": "MD205498",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zipei Feng, MD, PHD
• Marian Fenimore, LCSW
• Ebony Skye Fenn, LPN
• Michael (Brian) Brian Fennerty, MD
• Nathan Wade Fennewald, PA-C
• Michelle Fenrick
• Emma Lee Fenske, DO
• Emily Fensterman, LMT
• Kirk Fenton
• Lynn Ann Fenton, M.D.

• All providers in Portland, OR
• Obstetrics & Gynecology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2023; 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.