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NICKOLAS ROCKENBACK MD
NPI 1013776178
Student in an Organized Health Care Education/Training Program in Portland, OR

Active since March 18, 2024PECOS Enrolled
1015 NW 22ND AVE, PORTLAND, OR 97210(503) 413-7711(503) 413-7361 Get Directions Write a Review

NPPES record last updated: March 18, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Nickolas Rockenback Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NICKOLAS ROCKENBACK MD (NPI 1013776178) is an individual student in an organized health care education/training program in Portland, Oregon and active in the NPI registry since March 2024. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1013776178
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameNICKOLAS ROCKENBACKCredential: MD
Location Address1015 NW 22ND AVEPortland, OR 97210-3025
Mailing Address400 Spring St Apt 114Saint Paul, MN 55102-4438 · (651) 410-4621
Phone(503) 413-7711
Fax(503) 413-7361
Sole ProprietorNo
Enumeration DateMarch 18, 2024
NPPES CertifiedMarch 18, 2024
✔ NPI 1013776178 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
1015 NW 22ND AVE, Portland, OR 97210
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Nickolas Rockenback Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TSYRIA SHIANN TANG DO
Internal Medicine
1015 NW 22ND AVE
PORTLAND, OR 97210
Multnomah County (503) 413-7036
MARK A CRISLIP
Internal Medicine (Infectious Disease)
1015 NW 22ND AVE, R200
PORTLAND, OR 97210
Multnomah County (503) 413-8258
COLTON PATRICK BONEY DO
Student in an Organized Health Care Education/Training Program
1015 NW 22ND AVE
PORTLAND, OR 97210
Multnomah County (503) 413-7711
CAROLYN N RHETT MD
Emergency Medicine
1015 NW 22ND AVE
PORTLAND, OR 97210
Multnomah County (503) 413-7260
BRIAN BATTALIA MD
Internal Medicine
1015 NW 22ND AVE
PORTLAND, OR 97210
Multnomah County (503) 464-9034
DR. JUDITH ANN RAY M.D.
Pathology (Anatomic Pathology & Clinical Pathology)
1015 NW 22ND AVE
PORTLAND, OR 97210
Multnomah County (503) 413-8259
JENELLE LYNN STINSON PHARMD
Pharmacist
1015 NW 22ND AVE
PORTLAND, OR 97210
Multnomah County (503) 413-7008
DR. JENNIFER L LETOURNEAU DO
Internal Medicine (Critical Care Medicine)
1015 NW 22ND AVE
PORTLAND, OR 97210
Multnomah County (503) 413-8256

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nickolas Rockenback's NPI number?

The NPI number for Nickolas Rockenback is 1013776178. It was assigned to this individual provider in the NPPES registry on March 18, 2024.

Where is Nickolas Rockenback located?

Nickolas Rockenback practices at 1015 NW 22nd Ave, Portland, OR 97210. The listed phone number is (503) 413-7711.

What is Nickolas Rockenback's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Nickolas Rockenback enrolled in Medicare?

Yes. Nickolas Rockenback is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Nickolas Rockenback was last updated on March 18, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.