1. Home
  2. Directory
  3. Oregon
  4. Portland
  5. Nurse Practitioner
  6. NPI Profile
Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

RUDY ROQUE NP
NPI 1831933100
Nurse Practitioner - Psychiatric/Mental Health in Portland, OR

Active since June 21, 2024PECOS Enrolled
1410 NE 106TH AVE, PORTLAND, OR 97220(503) 460-0405(503) 460-0434 Get Directions Write a Review

NPPES record last updated: October 22, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Rudy Roque Np NPPES

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

RUDY ROQUE NP (NPI 1831933100) is an individual psychiatric/mental health provider in Portland, Oregon, licensed in Oregon (10050382) and active in the NPI registry since June 2024. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1831933100
Entity TypeIndividualMale
Primary Taxonomy363LP0808X
Provider Legal NameRUDY ROQUECredential: NP
Location Address1410 NE 106TH AVEPortland, OR 97220-3934
Mailing Address1410 Ne 106th AvePortland, OR 97220-3934 · (503) 460-0405 · Fax (503) 460-0434
Phone(503) 460-0405
Fax(503) 460-0434
Sole ProprietorNo
Enumeration DateJune 21, 2024
Last NPPES UpdateOctober 22, 2026
NPPES CertifiedOctober 22, 2026
✔ NPI 1831933100 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in OR · 10050382
1410 NE 106TH AVE, Portland, OR 97220
Open in Google Maps ↗

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Rudy Roque Np 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 Reassignments

2

Medicare enrollment records show Rudy Roque reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Bridge City Family Medical Clinic, PC
Same address
Multi-Specialty
1410 NE 106TH AVE
Portland, OR 97220
  • Reassigned Medicare billing, Oregon enrollment
  • 14 clinicians in this Medicare group
NPI 1548330715 (503) 460-0405
Amygdala Medical Corporation
847 mi
Psychiatric/Mental Health
2230 W CHAPMAN AVE STE 214B
Orange, CA 92868
  • Reassigned Medicare billing, California enrollment
  • 16 clinicians in this Medicare group
NPI 1386324267 (714) 712-0711

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 97220 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 14

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

KACY L HERBST PMHNP-BC
Nurse Practitioner (Psychiatric/Mental Health)
1410 NE 106TH AVE
PORTLAND, OR 97220
Multnomah County (503) 460-0405
ANGELINA M POLITO PMHNP-BC
Nurse Practitioner (Psychiatric/Mental Health)
1410 NE 106TH AVE
PORTLAND, OR 97220
Multnomah County (503) 460-0405
BRITNEY HERMAN NP-C WHNP-BC
Nurse Practitioner
1410 NE 106TH AVE
PORTLAND, OR 97220
Multnomah County (503) 460-0405
CHELSEA MARIE JOHNSON
Nurse Practitioner (Primary Care)
1410 NE 106TH AVE
PORTLAND, OR 97220
Multnomah County (503) 460-0405
THERESA BUNKER FNP
Nurse Practitioner (Family)
1410 NE 106TH AVE
PORTLAND, OR 97220
Multnomah County (503) 460-0405
DR. BRITTANY LYN KOLLURU N.D.
Naturopath
1410 NE 106TH AVE
PORTLAND, OR 97220
Multnomah County (503) 460-0405
JANE LOUISE IRVIN DECKER FNP-C
Nurse Practitioner (Family)
1410 NE 106TH AVE
PORTLAND, OR 97220
Multnomah County (503) 460-0405
BRIDGE CITY FAMILY MEDICAL CLINIC, PC
Clinic/Center (Multi-Specialty)
1410 NE 106TH AVE
PORTLAND, OR 97220
Multnomah County (503) 460-0405

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 Rudy Roque's NPI number?

The NPI number for Rudy Roque is 1831933100. It was assigned to this individual provider in the NPPES registry on June 21, 2024.

Where is Rudy Roque located?

Rudy Roque practices at 1410 NE 106th Ave, Portland, OR 97220. The listed phone number is (503) 460-0405.

What is Rudy Roque's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Rudy Roque enrolled in Medicare?

Yes. Rudy Roque is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Rudy Roque's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Rudy Roque reassigns Medicare benefits to 2 organizations: Bridge City Family Medical Clinic, PC (Portland, OR) and Amygdala Medical Corporation (Orange, CA). Each 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 Rudy Roque's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Rudy Roque was last updated on October 22, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.