- Medicare in Portland, OR

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is a medicare enrolled "Skilled Nursing Facility" provider in Portland, Oregon. Their current practice location is 12441 Se Stark St, Portland, Oregon. You can reach out to their office (for appointments etc.) via phone at (503) 255-7040.

is licensed to practice in * (Not Available) (license number ) and it also participates in the medicare program. is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1104530492.

Contact Information

12441 Se Stark St,
Portland, OR 97233-1053
(503) 255-7040
Not Available

Map and Direction




Healthcare Provider's Profile

Full Name
TypeFacility
SpecialitySkilled Nursing Facility
Location12441 Se Stark St, Portland, Oregon
Accepts Medicare AssignmentsMedicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1104530492
  • Provider Enumeration Date: 01/11/2023
  • Last Update Date: 09/05/2024
  Medicare PECOS Information:
  • PECOS PAC ID: 3870948391
  • Enrollment ID: O20231018001197

Medical Identifiers

Medical identifiers for such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1104530492NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
225100000XPhysical Therapist (* (Not Available))Secondary
225X00000XOccupational Therapist (* (Not Available))Secondary
227900000XRespiratory Therapist, Registered (* (Not Available))Secondary
235Z00000XSpeech-language Pathologist (* (Not Available))Secondary
314000000XSkilled Nursing Facility (* (Not Available))Primary

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. 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 AddressPractice Location Address

1777 Avenue Of The States Ste 102,
Lakewood, NJ 08701-4779

Ph: (732) 366-8300
12441 Se Stark St,
Portland, OR 97233-1053

Ph: (503) 255-7040

Reviews and Comments



Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.