MUSAH N IDDRISU RN
NPI 1124627054
Nurse Practitioner in Portland, OR

Q: What is Musah Iddrisu's NPI number?

The NPI number for Musah Iddrisu is 1124627054. It was assigned to this individual provider in the NPPES registry on October 21, 2020.

Q: What is Musah Iddrisu's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Q: When was this NPI record last updated?

The NPPES record for Musah Iddrisu was last updated on November 7, 2023. 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.

Active since October 21, 2020PECOS Enrolled

12710 SE DIVISION ST, PORTLAND, OR 97236(503) 988-3601 Get Directions Write a Review

NPPES record last updated: November 7, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Nov 7, 2023, Oct 21, 2020 (2 updates tracked since 2020).

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About Musah N Iddrisu Rn NPPES

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

MUSAH N IDDRISU RN (NPI 1124627054) is an individual nurse practitioner in Portland, Oregon, licensed in Oregon (10017169) and active in the NPI registry since October 2020. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1124627054

Entity TypeIndividualMale

Primary Taxonomy363L00000X

Provider Legal NameMUSAH N IDDRISUCredential: RN

Location Address12710 SE DIVISION STPortland, OR 97236-3134

Mailing Address619 Nw 6th Ave Fl 5Portland, OR 97209-3964 · (503) 988-7468

Phone(503) 988-3601

Sole ProprietorNo

Enumeration DateOctober 21, 2020

Last NPPES UpdateNovember 7, 20232 updates tracked since enumeration

NPPES CertifiedNovember 7, 2023

✔ NPI 1124627054 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in OR · 10017169

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

12710 SE DIVISION ST, Portland, OR 97236

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Musah N Iddrisu Rn 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.

Medicare Billing Reassignments

Medicare enrollment records show Musah Iddrisu reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Multnomah County

Same address

Federally Qualified Health Center (FQHC)

12710 SE DIVISION ST
Portland, OR 97236

Reassigned Medicare billing, Oregon enrollment
215 clinicians in this Medicare group

NPI 1245378322 (503) 988-3663

Peacehealth Networks On Demand, LLC

12 mi

General Practice

11958 SW GARDEN PL
Tigard, OR 97223

Reassigned Medicare billing, Oregon enrollment
87 clinicians in this Medicare group

NPI 1023582178 (503) 684-8252

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 97236 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$90.51 typical visit price

range $58.99 – $176.88

Typical copayment $22.62 (range $14.74 – $44.22)

Most-billed visit code 99203

Established Patient

$103.51 typical visit price

range $19.32 – $144.79

Typical copayment $25.87 (range $4.83 – $36.19)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

DR. SERGEY Y KIRPICHENKO DMD

Dentist (General Practice)