Ms Kimberly Susan Shotz, WHCNP, LAC is a medicare enrolled "Nurse Practitioner - Women's Health" provider in Portland, Oregon. Her current practice location is
5050 Ne Hoyt St Ste 353, Portland, Oregon. You can reach out to her office (for appointments etc.) via phone at
(503) 297-4123.
Ms Kimberly Susan Shotz is licensed to practice in Oregon (license number OR 093006979N7) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1003908120.
Healthcare Provider's Profile
| Full Name | Ms Kimberly Susan Shotz |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Women's Health |
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| Location | 5050 Ne Hoyt St Ste 353, Portland, Oregon |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1003908120
- Provider Enumeration Date: 09/28/2006
- Last Update Date: 09/21/2022
Medicare PECOS Information:
- PECOS PAC ID: 3274658042
- Enrollment ID: I20100916000798
Medical Identifiers
Medical identifiers for Ms Kimberly Susan Shotz such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1003908120 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 171100000X | Acupuncturist | AC156829 (Oregon) | Secondary |
| 363LW0102X | Nurse Practitioner - Women's Health | OR 093006979N7 (Oregon) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Ms Kimberly Susan Shotz allows following entities to bill medicare on her behalf.
| Provider Name | The Oregon Clinic, Pc |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1265417174
PECOS PAC ID: 2860390408
Enrollment ID: O20031222000096 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ms Kimberly Susan Shotz is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Ms Kimberly Susan Shotz, WHCNP, LAC
6018 Se Stark St, Ste 103,
Portland, OR 97215-1990
Ph: (503) 318-3352 | Ms Kimberly Susan Shotz, WHCNP, LAC
5050 Ne Hoyt St Ste 353,
Portland, OR 97213-2983
Ph: (503) 297-4123 |
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