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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

ATHENA NICOLE KONICKI MD
NPI 1508509050
Family Medicine in Portland, OR

Active since April 13, 2022PECOS Enrolled
10803 SE CHERRY BLOSSOM DR, PORTLAND, OR 97216(503) 261-7200(503) 261-7226 Get Directions Write a Review

NPPES record last updated: September 14, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Sep 14, 2026, Apr 13, 2022 (2 updates tracked since 2022).

About Athena Nicole Konicki Md NPPES

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

ATHENA NICOLE KONICKI MD (NPI 1508509050) is an individual family medicine provider in Portland, Oregon, licensed in Oregon (MD223694) and active in the NPI registry since April 2022. She is enrolled in Medicare PECOS and maintains a secondary practice location in Vancouver.

NPPES Registry Identity

NPI1508509050
Entity TypeIndividualFemale
Primary Taxonomy207Q00000X
Provider Legal NameATHENA NICOLE KONICKICredential: MD
Location Address10803 SE CHERRY BLOSSOM DRPortland, OR 97216-3107
Mailing Address10803 Se Cherry Blossom DrPortland, OR 97216-3107 · (503) 261-7200 · Fax (503) 261-7226
Phone(503) 261-7200
Fax(503) 261-7226
Sole ProprietorNo
Enumeration DateApril 13, 2022
Last NPPES UpdateSeptember 14, 20262 updates tracked since enumeration
NPPES CertifiedSeptember 14, 2026
✔ NPI 1508509050 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in OR · MD223694
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
10803 SE CHERRY BLOSSOM DR, Portland, OR 97216
Open in Google Maps ↗

Secondary Practice Location 1

Location 1100 E 33rd St Ste 100Vancouver, WA 98663-2776 · Phone (360) 514-7550

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Athena Nicole Konicki 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.

Medicare Billing Reassignment

Medicare enrollment records show Athena Konicki reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Kaiser Foundation Health Plan Of The Northwest
4.0 mi
General Practice
3060 SE HAWTHORNE BLVD
Portland, OR 97214
  • Reassigned Medicare billing, Oregon and Washington enrollments
  • Also billed through NPI 1871848457 (Washington)
  • 3,207 clinicians in this Medicare group
NPI 1063990695 (800) 813-2000

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 97216 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. TIMOTHY P JANZEN M.D.
Family Medicine
10803 SE CHERRY BLOSSOM DR
PORTLAND, OR 97216
Multnomah County (503) 261-7200
JOSHUA M REESE MD
Family Medicine
10803 SE CHERRY BLOSSOM DR
PORTLAND, OR 97216
Multnomah County (503) 261-7200
MS. JENNIFER MARIE STAGER BS, MMS, PA-C
Physician Assistant
10803 SE CHERRY BLOSSOM DR
PORTLAND, OR 97216
Multnomah County (503) 261-7200
DR. WALTER E NORTON M.D.
Family Medicine
10803 SE CHERRY BLOSSOM DR
PORTLAND, OR 97216
Multnomah County (503) 261-7200
DR. BRUCE C DOUGLAS M.D.
Family Medicine
10803 SE CHERRY BLOSSOM DR
PORTLAND, OR 97216
Multnomah County (503) 261-7200
DR. JEANA M CROVER M.D.
Family Medicine
10803 SE CHERRY BLOSSOM DR
PORTLAND, OR 97216
Multnomah County (503) 261-7200
MISS MEGAN HUANG PA
Physician Assistant
10803 SE CHERRY BLOSSOM DR
PORTLAND, OR 97216
Multnomah County (503) 261-7200
ALEXANDRA CONNER PA
Physician Assistant
10803 SE CHERRY BLOSSOM DR
PORTLAND, OR 97216
Multnomah County (503) 261-7210

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 Athena Konicki's NPI number?

The NPI number for Athena Konicki is 1508509050. It was assigned to this individual provider in the NPPES registry on April 13, 2022.

Where is Athena Konicki located?

Athena Konicki practices at 10803 SE Cherry Blossom Dr, Portland, OR 97216. The listed phone number is (503) 261-7200.

What is Athena Konicki's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Athena Konicki enrolled in Medicare?

Yes. Athena Konicki is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Athena Konicki's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Athena Konicki reassigns Medicare benefits to Kaiser Foundation Health Plan Of The Northwest (Portland, OR). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Athena Konicki's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Athena Konicki was last updated on September 14, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 53 days 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.