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STACEY L WILSON CNM
NPI 1629102272
Nurse Practitioner - Obstetrics & Gynecology in Beaverton, OR

Active since March 15, 2007PECOS Enrolled
4855 SW WESTERN AVE, BEAVERTON, OR 97005(503) 626-5515 Get Directions Write a Review

NPPES record last updated: April 29, 2008. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Stacey L Wilson Cnm NPPES

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

STACEY L WILSON CNM (NPI 1629102272) is an individual obstetrics & gynecology provider in Beaverton, Oregon, licensed in Oregon (OR 200050017NP) and active in the NPI registry since March 2007. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1629102272
Entity TypeIndividualFemale
Primary Taxonomy363LX0001X
Provider Legal NameSTACEY L WILSONCredential: CNM
Location Address4855 SW WESTERN AVEBeaverton, OR 97005-3460
Mailing Address8646 Nw Skyline BlvdPortland, OR 97231-2618
Phone(503) 626-5515
Sole ProprietorNo
Enumeration DateMarch 15, 2007
Last NPPES UpdateApril 29, 2008
✔ NPI 1629102272 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Obstetrics & GynecologyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LX0001X
License✔ Licensed in OR · OR 200050017NP
4855 SW WESTERN AVE, Beaverton, OR 97005
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Kaiser Permanente.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Stacey L Wilson Cnm 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 Stacey Wilson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Beaverton Rehab & Specialty Care, LLC
1.0 mi
Skilled Nursing Facility
11850 SW ALLEN BLVD
Beaverton, OR 97005
  • Reassigned Medicare billing, Oregon and Washington enrollments
  • Medicare enrollment name: Kaiser Foundation Health Plan Of The Northwest
  • Also billed through NPI 1184786527 (Washington)
  • 3,207 clinicians in this Medicare group
NPI 1366469330 (503) 646-7164

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 97005 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.

MRS. RANDEEP KAUR DA
Dental Assistant
4855 SW WESTERN AVE
BEAVERTON, OR 97005
Washington County (503) 626-4148
CHANNA V HANG PA
Physician Assistant
4855 SW WESTERN AVE
BEAVERTON, OR 97005
Washington County (503) 813-2000
MEDHA CHUNDURU MD
Family Medicine
4855 SW WESTERN AVE
BEAVERTON, OR 97005
Washington County (800) 813-2000
MARYLOU STRONG
Physical Therapist
4855 SW WESTERN AVE
BEAVERTON, OR 97005
Washington County (503) 520-4950
BRADLEY RAY PLANT DPT, CSCS
Physical Therapist
4855 SW WESTERN AVE
BEAVERTON, OR 97005
Washington County (800) 813-2000
AMANDA ANDERSEN
Internal Medicine
4855 SW WESTERN AVE
BEAVERTON, OR 97005
Washington County (503) 813-2000
TINA TRUONG
Dental Hygienist
4855 SW WESTERN AVE
BEAVERTON, OR 97005
Washington County (800) 213-2000
SANDRA MEACHAM REED M.D.
Obstetrics & Gynecology
4855 SW WESTERN AVE
BEAVERTON, OR 97005
Washington County (503) 643-7565

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 Stacey Wilson's NPI number?

The NPI number for Stacey Wilson is 1629102272. It was assigned to this individual provider in the NPPES registry on March 15, 2007.

Where is Stacey Wilson located?

Stacey Wilson practices at 4855 SW Western Ave, Beaverton, OR 97005. The listed phone number is (503) 626-5515.

What is Stacey Wilson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Obstetrics & Gynecology, with taxonomy code 363LX0001X.

Is Stacey Wilson enrolled in Medicare?

Yes. Stacey Wilson is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Stacey Wilson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Stacey Wilson reassigns Medicare benefits to Beaverton Rehab & Specialty Care, LLC (Beaverton, 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 Stacey Wilson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Stacey Wilson accept?

Health plans from Kaiser Permanente list Stacey Wilson 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 Stacey Wilson was last updated on April 29, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.