Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mrs. Stacy Marie Rudy, PA-C

Individual provider Physician Assistant · NPI 1154713188

Mrs. Stacy Marie Rudy, PA-C is a Physician Assistant in Portland, Oregon. Qualified in 2016, 10 years ago. Practices with Portland Clinic, a 93-clinician group and accepts Medicare assignment. Licensed in Oregon.

Years since qualifying
10
Licensed in
OR
In the registry since
2015
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

6640 SW Redwood Ln
Portland, OR 97224-7187
Phone: (503) 620-7358
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA179627 (OR)

Record details

NPI number1154713188
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedFebruary 27, 2015
Last updated in NPPESNovember 18, 2020
Certification dateNovember 18, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Portland Clinic — 93 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

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