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

Q: 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.

Q: What is Stacey Wilson's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Stacey Wilson was last updated on April 29, 2008. NPI Profile syncs with the weekly NPPES data releases published by CMS.

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: July 26, 2026.

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

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.

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.

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Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

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