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Lola Achilova

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

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

PECOS Enrollment

Based on the most recent information from CMS, provider Lola Achilova 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
1548546328
Provider Type
Individual
Full Name
Achilova, Lola
Credential
P.A.-C

Gender
Female
Sole Proprietor
No
Enumeration Date
10/25/2011
Last Updated
6/18/2025

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 PA156316 Oregon
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA156316 Oregon

Provider Identifiers

ID	Description	Issuer
ID 500641265	Description Medicaid	Issuer Unlisted Oregon

Lola Achilova

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Moody, Samuel

Walter, Molly Ann

Benjamin, Christopher

Schulzetenberg, Briana

Gu, Melody W

Fix, Paxton

Bischof, Katherine Elaine

Masterson, Rachael

Felder, Kimberly Kay

Friberg, Whitni Nicole