Agestrong Holladay Park Plaza - Medicare in Portland, OR

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Agestrong Holladay Park Plaza is a medicare enrolled "Clinic/center - Rehabilitation" provider in Portland, Oregon. Their current practice location is 1300 Ne 16th Ave, Portland, Oregon. You can reach out to their office (for appointments etc.) via phone at (503) 288-6671.

Agestrong Holladay Park Plaza is licensed to practice in * (Not Available) (license number ) and it also participates in the medicare program. Agestrong Holladay Park Plaza 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 1952075962.

Contact Information

Agestrong Holladay Park Plaza
1300 Ne 16th Ave,
Portland, OR 97232-1467
(503) 288-6671
Not Available

Map and Direction




Healthcare Provider's Profile

Full NameAgestrong Holladay Park Plaza
TypeFacility
SpecialityClinic/center - Rehabilitation
Location1300 Ne 16th Ave, Portland, Oregon
Accepts Medicare AssignmentsMedicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1952075962
  • Provider Enumeration Date: 08/03/2021
  • Last Update Date: 02/19/2024
  Medicare PECOS Information:
  • PECOS PAC ID: 6507254497
  • Enrollment ID: O20211026002073

Medical Identifiers

Medical identifiers for Agestrong Holladay Park Plaza such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1952075962NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
225100000XPhysical Therapist (* (Not Available))Secondary
225X00000XOccupational Therapist (* (Not Available))Secondary
235Z00000XSpeech-language Pathologist (* (Not Available))Secondary
261QR0400XClinic/center - Rehabilitation (* (Not Available))Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Agestrong Holladay Park Plaza acts as a billing entity for following providers:
Provider NameCourtney Basile
Provider TypePractitioner - Occupational Therapist In Private Practice
Provider IdentifiersNPI Number: 1053402578
PECOS PAC ID: 3274522719
Enrollment ID: I20040510000765
Provider NameZachary S Kinzer
Provider TypePractitioner - Occupational Therapist In Private Practice
Provider IdentifiersNPI Number: 1437240967
PECOS PAC ID: 7416932322
Enrollment ID: I20040623000755
Provider NameJennifer S Blake
Provider TypePractitioner - Physical Therapist In Private Practice
Provider IdentifiersNPI Number: 1154491777
PECOS PAC ID: 2163671959
Enrollment ID: I20121011000745
Provider NameAmber Lindsey Kozlov
Provider TypePractitioner - Physical Therapist In Private Practice
Provider IdentifiersNPI Number: 1801101746
PECOS PAC ID: 3779724729
Enrollment ID: I20130802000457
Provider NameRebecca J Staples
Provider TypePractitioner - Physical Therapist In Private Practice
Provider IdentifiersNPI Number: 1659502557
PECOS PAC ID: 0143655399
Enrollment ID: I20200512003802
Provider NameJeremy Ray Kennedy
Provider TypePractitioner - Physical Therapist In Private Practice
Provider IdentifiersNPI Number: 1982034286
PECOS PAC ID: 2264846302
Enrollment ID: I20210201000375
Provider NamePatricia K Suhr
Provider TypePractitioner - Physical Therapist In Private Practice
Provider IdentifiersNPI Number: 1780355057
PECOS PAC ID: 0446648232
Enrollment ID: I20211027003046
Provider NameNicole Haywood
Provider TypePractitioner - Physical Therapist In Private Practice
Provider IdentifiersNPI Number: 1821577065
PECOS PAC ID: 7810385325
Enrollment ID: I20211102000944
Provider NameKathleen Napolina Costers
Provider TypePractitioner - Qualified Speech Language Pathologist
Provider IdentifiersNPI Number: 1922514256
PECOS PAC ID: 0648661827
Enrollment ID: I20211222002259
Provider NameMichelle Diane Wood
Provider TypePractitioner - Occupational Therapist In Private Practice
Provider IdentifiersNPI Number: 1578664348
PECOS PAC ID: 0941692974
Enrollment ID: I20220124002548
Provider NameLori Ann Taylor
Provider TypePractitioner - Occupational Therapist In Private Practice
Provider IdentifiersNPI Number: 1275858565
PECOS PAC ID: 6406233105
Enrollment ID: I20220518002845
Provider NameMelinda Kaye Boffing
Provider TypePractitioner - Occupational Therapist In Private Practice
Provider IdentifiersNPI Number: 1043958796
PECOS PAC ID: 9739567637
Enrollment ID: I20220606001524
Provider NameAllison J Van Eerden
Provider TypePractitioner - Occupational Therapist In Private Practice
Provider IdentifiersNPI Number: 1376636076
PECOS PAC ID: 6406235225
Enrollment ID: I20220623003187
Provider NameAlexandra Kristine Thomas
Provider TypePractitioner - Physical Therapist In Private Practice
Provider IdentifiersNPI Number: 1023590486
PECOS PAC ID: 6103206669
Enrollment ID: I20220630002191
Provider NameDexter Jay Carolino
Provider TypePractitioner - Physical Therapist In Private Practice
Provider IdentifiersNPI Number: 1912395195
PECOS PAC ID: 9537549571
Enrollment ID: I20220707002591
Provider NameLindsay Barrett
Provider TypePractitioner - Qualified Speech Language Pathologist
Provider IdentifiersNPI Number: 1649647405
PECOS PAC ID: 8224418959
Enrollment ID: I20220712000730
Provider NameNicolle Lynn Keele
Provider TypePractitioner - Physical Therapist In Private Practice
Provider IdentifiersNPI Number: 1972680999
PECOS PAC ID: 0244611986
Enrollment ID: I20220713000983
Provider NameJohn Barnhill
Provider TypePractitioner - Physical Therapist In Private Practice
Provider IdentifiersNPI Number: 1053401463
PECOS PAC ID: 6305227083
Enrollment ID: I20220713002141
Provider NameMary Elizabeth Wingard
Provider TypePractitioner - Occupational Therapist In Private Practice
Provider IdentifiersNPI Number: 1720179526
PECOS PAC ID: 6800277419
Enrollment ID: I20220713003406
Provider NameLouie James Nuyda Santos
Provider TypePractitioner - Physical Therapist In Private Practice
Provider IdentifiersNPI Number: 1861815516
PECOS PAC ID: 2163890526
Enrollment ID: I20221116002575
Provider NameSheena Waldron
Provider TypePractitioner - Qualified Speech Language Pathologist
Provider IdentifiersNPI Number: 1093428302
PECOS PAC ID: 4183095276
Enrollment ID: I20230127002721
Provider NameStacey L S Moore
Provider TypePractitioner - Occupational Therapist In Private Practice
Provider IdentifiersNPI Number: 1558426593
PECOS PAC ID: 9739534199
Enrollment ID: I20231005000779
Provider NameDaniel Nicholas Canchola
Provider TypePractitioner - Occupational Therapist In Private Practice
Provider IdentifiersNPI Number: 1154570026
PECOS PAC ID: 2062860372
Enrollment ID: I20231128000816
Provider NameJaclyn Ann Sinauskas
Provider TypePractitioner - Occupational Therapist In Private Practice
Provider IdentifiersNPI Number: 1326406851
PECOS PAC ID: 2961851928
Enrollment ID: I20231215001808
Provider NameEmily Vandekieft
Provider TypePractitioner - Occupational Therapist In Private Practice
Provider IdentifiersNPI Number: 1073206959
PECOS PAC ID: 5991158271
Enrollment ID: I20240202001859
Provider NameHannah Elizabeth Lanstrum
Provider TypePractitioner - Physical Therapist In Private Practice
Provider IdentifiersNPI Number: 1518189455
PECOS PAC ID: 5193169845
Enrollment ID: I20240221001257
Provider NameMary Catherine Smith
Provider TypePractitioner - Qualified Speech Language Pathologist
Provider IdentifiersNPI Number: 1477912277
PECOS PAC ID: 0840639092
Enrollment ID: I20240419002966
Provider NameMary Stewart
Provider TypePractitioner - Physical Therapist In Private Practice
Provider IdentifiersNPI Number: 1720232069
PECOS PAC ID: 6103265103
Enrollment ID: I20240423002072
Provider NameSharon Faye Anoff
Provider TypePractitioner - Physical Therapist In Private Practice
Provider IdentifiersNPI Number: 1528214293
PECOS PAC ID: 3779923537
Enrollment ID: I20240428000005

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. Agestrong Holladay Park Plaza 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
Agestrong Holladay Park Plaza
4560 Se International Way Ste 100,
Milwaukie, OR 97222-4628

Ph: (971) 206-5200		Agestrong Holladay Park Plaza
1300 Ne 16th Ave,
Portland, OR 97232-1467

Ph: (503) 288-6671

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.

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