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DR. NICKY JO LEEBORG M.D.
NPI 1790921005
Student in an Organized Health Care Education/Training Program in Portland, OR

Active since December 17, 2008PECOS EnrolledAccepts Medicare Assignment
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239(503) 494-2310 Get Directions Write a Review

NPPES record last updated: February 1, 2022. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Dr. Nicky Jo Leeborg M.d. NPPES

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

DR. NICKY JO LEEBORG M.D. (NPI 1790921005) is an individual student in an organized health care education/training program in Portland, Oregon, licensed in Oregon (MD27627) and active in the NPI registry since December 2008. She is enrolled in Medicare PECOS and is a graduate of State University Of Ny Upstate Medical University (2003).

NPPES Registry Identity

NPI1790921005
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameDR. NICKY JO LEEBORGCredential: M.D.
Location Address3181 SW SAM JACKSON PARK RDPortland, OR 97239-3011
Mailing Address3181 Sw Sam Jackson Park RdPortland, OR 97239-3011 · (503) 494-2310
Phone(503) 494-2310
Sole ProprietorNo
Medical School CMSState University Of Ny Upstate Medical UniversityGraduated 2003
Enumeration DateDecember 17, 2008
Last NPPES UpdateFebruary 1, 2022
✔ NPI 1790921005 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
License✔ Licensed in OR · MD27627
Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

3181 SW SAM JACKSON PARK RD, Portland, OR 97239
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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

Dr. Nicky Jo Leeborg M.d. 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 ID42366676
PECOS Enrollment IDI20090922000784
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.

JERRIS ROBERT HEDGES MD, MS, MMM
Emergency Medicine
3181 SW SAM JACKSON PARK RD, # L-102
PORTLAND, OR 97239
Multnomah County (503) 494-2767
DR. BRANDON ZANE HOROWITZ M.D.
Emergency Medicine
3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239
Multnomah County (503) 494-4833
MARY ANN BROWNING FNP
Nurse Practitioner (Family)
3181 SW SAM JACKSON PARK RD, CDW-EM
PORTLAND, OR 97239
Multnomah County (503) 494-7500
DR. ROBERT AUGUSTUS LOWE MD, MPH
Emergency Medicine
3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239
Multnomah County (503) 494-7134
DR. MOHAMUD RAMZANALI DAYA MD, M S
Emergency Medicine
3181 SW SAM JACKSON PARK RD, MAILCODE CDW-EM
PORTLAND, OR 97239
Multnomah County (503) 494-7248
DR. RITU SAHNI MD
Emergency Medicine
3181 SW SAM JACKSON PARK RD, # CDW
PORTLAND, OR 97239
Multnomah County (503) 494-7500
DR. ALFREDO SABBAJ MD
Emergency Medicine
3181 SW SAM JACKSON PARK RD, MAIL CODE: CDW-EM
PORTLAND, OR 97239
Multnomah County (503) 494-1475
ROBERT G HENDRICKSON MD
Emergency Medicine (Medical Toxicology)
3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239
Multnomah County (503) 494-9495

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 Nicky Leeborg's NPI number?

The NPI number for Nicky Leeborg is 1790921005. It was assigned to this individual provider in the NPPES registry on December 17, 2008.

Where is Nicky Leeborg located?

Nicky Leeborg practices at 3181 SW Sam Jackson Park Rd, Portland, OR 97239. The listed phone number is (503) 494-2310.

What is Nicky Leeborg's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Nicky Leeborg enrolled in Medicare?

Yes. Nicky Leeborg 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.

When was this NPI record last updated?

The NPPES record for Nicky Leeborg was last updated on February 1, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.