Ami Formica , MA, LPCA
Counselor - Professional • Bend, OR
497 Sw Century Dr Ste 102
Bend, OR 977021167
This profile restates public CMS/NPPES data; T-MedInfo gives no medical advice — consult a licensed professional, and call 911 for emergencies.
Practice Location & Contact Primary Location
497 Sw Century Dr Ste 102
Bend, OR 977021167
Matched by practice address or phone in NPPES. A shared address or phone does not confirm that this clinician works there.
What Public CMS Data Show
Counselor - Professional: NPPES taxonomy is a reported classification, not proof of board certification.
NPI first issued
2026
The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.
What this does not show: NPI first issued
NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.
Source: CMS NPPES NPI Registry.
Medicare assignment not listed
CMS data do not show whether this clinician accepts Medicare assignment. This does not mean they do not accept Medicare. Ask the office.
Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.
Source: CMS Doctors and Clinicians; Medicare.gov, “Does your provider accept Medicare as full payment?”
No telehealth indicator
CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.
Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.
Compared with the same specialty in Bend and Oregon
210 active clinicians are listed under Counselor - Professional with a practice address in Bend, OR (2,559 in Oregon).
Addresses are self-reported to NPPES and may be out of date.
Telehealth indicator in Bend
4.8% of these 210 clinicians have the CMS telehealth indicator.
16.7% of these 210 clinicians are listed by CMS as accepting Medicare assignment.
Sources: CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.
Text: T-MedInfo · Report an error.
Specialties & License Numbers Reported to NPPES
Self-certified to NPPES: 2026-07-29NUCC Taxonomy Code: 101YP2500X
Clinicians Sharing This Practice Address or Phone
Clinicians sharing this NPPES address, phone or fax; a shared contact does not mean they work together.
Social Worker - Clinical
Licensed Clinical Social Worker
Career & Practice History
NPI enumerated July 29, 2026.
This record first appears in the August 2026 NPPES data file, the latest one loaded here, so there is no change history for it yet.
NPI Administrative Meta
Mailing Address
497 Sw Century Dr Ste 102
Bend, OR 977021167
Phone: 2012330293