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

Q: 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.

Q: What is Athena Konicki's specialty?

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

Q: 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 12 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.

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: September 20, 2026.

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

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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

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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, and ordering and referring status from the CMS PECOS system.

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.

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