Independent US Healthcare Provider Directory & Public Medical Database Patient Guides

Nicky Callicotte

Social Worker β€’ Sandy, OR

Active NPI 1205084845 Individual Practitioner Female Practitioner Accepts Medicare assignment
Practice location in NPPES

36860 Industrial Way
Sandy, OR 970557371

Call 5038260206 Location details and other listings
Medical Disclaimer

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

Practice Address

36860 Industrial Way

Sandy, OR 970557371

Telephone 5038260206
Organization at the Same NPPES Address or Phone
Legacy Clinics Llc Facility NPI 1730472192

Matched by practice address or phone in NPPES. A shared address or phone does not confirm that this clinician works there.

Other Listings in Public Data

NPPES lists 1 additional practice-address record in Portland, OR. See the list

Source: CMS NPPES NPI Registry, practice location records; release date unavailable.

CMS Doctors and Clinicians lists 1 group name: Legacy Clinics Llc. See the list

Source: CMS Doctors and Clinicians National Downloadable File, release date unavailable.

Listings do not confirm current availability, employment or a shared ownership network.

Medicare Profile & Education

Source: CMS Doctors and Clinicians National Downloadable File

Graduation Year

2014

Years since graduation

12 years (graduated 2014)

CMS Doctors and Clinicians data list 2014 as the year this clinician finished professional school.

What this does not show: Years since graduation

It is not the number of years in practice, and more years does not mean better care.

Source: CMS Doctors and Clinicians National Downloadable File.

NPI first issued

2008

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.

Accepts Medicare assignment

CMS data list this clinician as accepting Medicare assignment. This means agreeing to take the Medicare-approved amount as full payment for covered services.

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, β€œDoes your provider accept Medicare as full payment?”

Guide: What Medicare assignment means

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.

Guide: How Medicare covers telehealth

Enrolled in Medicare (PECOS)

Nicky Callicotte has a Medicare enrollment record in PECOS, the CMS system clinicians use to enroll so they can bill Medicare or order services for people with Medicare.

It does not show whether the clinician accepts assignment, is in your plan's network, or is taking new patients.

Source: CMS Medicare Fee-For-Service Public Provider Enrollment (PECOS); CMS Order and Referring file.

Guide: What Medicare enrollment (PECOS) means

Can order Medicare-covered services

CMS lists Nicky Callicotte as eligible to order or refer Medicare Part B clinical laboratory and imaging services and durable medical equipment (DME) for people with Medicare.

What this does not show: Can order Medicare-covered services

It does not mean the clinician offers these services directly.

Source: CMS Medicare Fee-For-Service Public Provider Enrollment (PECOS); CMS Order and Referring file.

Guide: What ordering and referring status means

Compared with the same specialty in Sandy and Oregon

1 active clinicians are listed under Social Worker with a practice address in Sandy, OR (2,104 in Oregon).

Addresses are self-reported to NPPES and may be out of date.

Sources: CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.

Text: T-MedInfo Β· Report an error.

Specialties & License Numbers Reported to NPPES

Self-certified to NPPES: 2024-06-06
Social Worker Primary Specialty

NUCC Taxonomy Code: 104100000X

License # reported to NPPES OR L11089

A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public.

Case Manager/Care Coordinator

NUCC Taxonomy Code: 171M00000X

A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee's progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management.

Check License Status with the State Board License numbers are self-reported to NPPES; T-MedInfo does not confirm them against state records. Current status: Oregon Medical Board.
Look Up on State Board Site

Medicare (PECOS) Enrollment & Ordering Eligibility

Source: CMS PECOS
Medicare FFS Enrollment Status Medicare Enrollment on File
CMS Provider Specialty

PRACTITIONER - CLINICAL SOCIAL WORKER

Medicare Enrollment ID

I20240702003235

Enrollment State Jurisdiction

OR

PECOS Control ID

5597209460

Medicare Order & Referring Eligibility
Clinical Lab & Imaging (Part B) Eligible
Durable Medical Equipment (DME) Eligible
Home Health Agency (HHA) Not Eligible
Power Mobility Devices (PMD) Not Eligible

Sources: CMS Provider Enrollment and Order and Referring. Medicare enrollment is a billing status, not an accreditation or quality rating.

Medicare Group Practice Enrollments

Source: CMS Doctors and Clinicians National Downloadable File

Legacy Clinics Llc

36860 Industrial Way, Sandy, OR 970557371

Phone: 5036684117

Secondary Practice Locations

847 Ne 19th Ave, Ste. 100

Portland, OR 972322684

Phone: 5035526203

Clinicians Sharing This Practice Address or Phone

Clinicians sharing this NPPES address, phone or fax; a shared contact does not mean they work together.

6 listed
Dr. Kristin Hart , PharmD

Pharmacist - Ambulatory Care

NPI 1710354576

Doctor of Pharmacy (Pharm.D.)

NPI 1336143932

Doctor of Medicine (M.D.)

Tara Pfaff , FNP-BC

Nurse Practitioner - Family

NPI 1053840330

Family Nurse Practitioner (Board Certified)

Dr. Sean Schulz , DO

Family Medicine

NPI 1164866885

Doctor of Osteopathic Medicine (D.O.)

NPI 1467456053

Doctor of Medicine (M.D.)

Dr. Deryk Zinser , DO

Family Medicine

NPI 1336371517

Doctor of Osteopathic Medicine (D.O.)

Career & Practice History Timeline

Changes recorded in monthly NPPES data files: addresses, names, credentials, specialties and NPI status

9 Historical Events
πŸ“
Updated Practice Location June 06, 2024

Registered at 36860 INDUSTRIAL WAY, SANDY, OR 970557371 (Tel: 5038260206)

πŸ“
Updated Business Mailing Address June 06, 2024

Registered at PO BOX 3777, PORTLAND, OR 972083777 (Tel: 5034133900)

πŸ‘€
Provider Name / Credentials Updated June 06, 2024

Recorded as NICKY CALLICOTTE

βœ…
NPI Profile Active September 08, 2008

NPI status registered as active in NPPES database

πŸ“
Practice Location (Initial Record) September 08, 2008

Registered at 847 NE 19TH AVE, STE. 100, PORTLAND, OR 972322684 (Tel: 5035526203)

πŸ“
Business Mailing Address (Initial Record) September 08, 2008

Registered at 847 NE 19TH AVE, STE. 100, PORTLAND, OR 972322684 (Tel: 5035526203)

πŸ‘€
Provider Name / Credentials (Initial Record) September 08, 2008

Recorded as NICKY MCLEAN

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) September 08, 2008

Case Manager/Care Coordinator

🟒
Initial NPI Registration & Enumeration September 08, 2008

First registered as active Individual Practitioner in NPPES Database.

No reviews have been published yet. Leave a review.

NPI Administrative Meta

NPI Number: 1205084845
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 08, 2008
Last Update: June 06, 2024
Sole Proprietor: Yes

Mailing Address

Po Box 3777

Portland, OR 972083777

Phone: 5034133900

About This Data NPPES fields (address, phone, specialty, license) are self-reported and may be outdated; Medicare fields follow the CMS dataset named in each section. Correct directly at NPPES.