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KIMBERLY A SAMUELS
NPI 1538824909
Counselor - Mental Health in Portland, OR

Active since November 01, 2021PECOS EnrolledAccepts Medicare Assignment
1507 NE 122ND AVE, PORTLAND, OR 97230(503) 258-4555 Get Directions Write a Review

NPPES record last updated: November 1, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Kimberly A Samuels NPPES

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

KIMBERLY A SAMUELS (NPI 1538824909) is an individual mental health provider in Portland, Oregon and active in the NPI registry since November 2021. She is enrolled in Medicare PECOS and is a graduate of Other (2021).

NPPES Registry Identity

NPI1538824909
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameKIMBERLY A SAMUELS
Location Address1507 NE 122ND AVEPortland, OR 97230-1911
Mailing Address1507 Ne 122nd AvePortland, OR 97230-1911 · (503) 258-4555
Phone(503) 258-4555
Sole ProprietorNo
Medical School CMSOtherGraduated 2021
Enumeration DateNovember 1, 2021
NPPES CertifiedNovember 1, 2021
✔ NPI 1538824909 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
1507 NE 122ND AVE, Portland, OR 97230
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Other Names 1

Professional Name (2)Azure Samuels

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Kaiser Permanente, Moda Health Plan, Inc. and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kimberly A Samuels is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2264967157
PECOS Enrollment IDI20241202002704
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.

RYAN DICKER
Social Worker
1507 NE 122ND AVE
PORTLAND, OR 97230
Multnomah County (503) 258-4555
DAYNA L SANDERS MSW
Social Worker (Clinical)
1507 NE 122ND AVE
PORTLAND, OR 97230
Multnomah County (503) 258-4116
CORYNN BERNHARDT CSWA, MSW
Social Worker
1507 NE 122ND AVE
PORTLAND, OR 97230
Multnomah County (503) 258-4555
MS. BARBARA ALISON PANKO QMHP
Counselor
1507 NE 122ND AVE
PORTLAND, OR 97230
Multnomah County (971) 917-6969
AVERY D'ALESSANDRO MSW
Counselor
1507 NE 122ND AVE
PORTLAND, OR 97230
Multnomah County (503) 258-4555
MS. MEGAN MITCHELL
Social Worker
1507 NE 122ND AVE
PORTLAND, OR 97230
Multnomah County (503) 258-4555
LAUREN KAPLAN PMHNP-BC
Nurse Practitioner (Psychiatric/Mental Health)
1507 NE 122ND AVE
PORTLAND, OR 97230
Multnomah County (503) 258-4555
DANIEL MCNICHOLAS
Counselor (Mental Health)
1507 NE 122ND AVE
PORTLAND, OR 97230
Multnomah County (503) 258-4599

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 Kimberly Samuels's NPI number?

The NPI number for Kimberly Samuels is 1538824909. It was assigned to this individual provider in the NPPES registry on November 1, 2021. The provider is also known as Azure Samuels.

Where is Kimberly Samuels located?

Kimberly Samuels practices at 1507 NE 122nd Ave, Portland, OR 97230. The listed phone number is (503) 258-4555.

What is Kimberly Samuels's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Kimberly Samuels enrolled in Medicare?

Yes. Kimberly Samuels is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Kimberly Samuels accept?

Health plans from BridgeSpan Health Company, Kaiser Permanente, Moda Health Plan, Inc., Providence Health Plan and Regence BlueCross BlueShield of Oregon list Kimberly Samuels as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kimberly Samuels was last updated on November 1, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.