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Mary Ellen Spencer

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011

PECOS Enrollment

This provider is enrolled in PECOS as MARY SPENCER.

Based on the most recent information from CMS, provider Mary Ellen Spencer is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1124619283
Provider Type
Individual
Full Name
Spencer, Mary Ellen
Credential
PA-C

Gender
Female
Sole Proprietor
No
Enumeration Date
2/1/2021
Last Updated
4/9/2024

Contact Information

Practice Location

3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011

(503) 418-4500

(503) 494-1678

Mailing Location

1400 SW 5th Ave Ste 500, Portland, OR 97201-5537

(866) 617-6855

(503) 346-8015

Provider Taxonomies

Code	Description	License
Code 363AM0700X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA217576 Oregon
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 025656 New York
Code 363L00000X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 025656 New York

Mary Ellen Spencer

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

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