Avamere at Three Fountains – Skilled Nursing Facility, NPI 1114965894

Avamere at Three Fountains is a healthcare provider. based in Wilsonville, Oregon. specializing in Skilled Nursing Facility. The NPI Number for Avamere at Three Fountains is 1114965894

Main info

Organization
Name
Avamere at Three Fountains
NPI
1114965894
Phone
Not provided
Address
25117 SW PARKWAY AVE
Authorized Official
K. RICKARD MILLER JR. MANAGER
Enumeration Date
3 June 2006
Last Update Date
21 January 2025

Contacts

Main Contact
https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinServi
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience55
Completeness90
Years active:20State licenses:0Updated within 12 months

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Provider Addresses for Avamere at Three Fountains

  • Signature, 25117, Southwest Parkway Avenue, Wilsonville, Metro, Washington County, Oregon, 97070, United States

    SUITE F

    WILSONVILLE, OR 970709600

    Phone:

    Type: Mailing

  • 835, Crater Lake Avenue, Medford, Jackson County, Oregon, 97504, United States

    MEDFORD, OR 975046505

    Phone: (541) 773-7717

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2006-07-21

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
O20060721000133OSkilled Nursing FacilityORTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 97070)

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Reviews

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Frequently asked questions

What NPI should I save for Avamere at Three Fountains?
Save NPI 1114965894 if you need a stable reference for Avamere at Three Fountains.
Is Avamere at Three Fountains's enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
Does Avamere at Three Fountains list a primary specialty?
If you are matching referrals, note Skilled Nursing Facility for Avamere at Three Fountains. Clinical services aligned with this taxonomy classification.
What location shows for Avamere at Three Fountains?
We surface Wilsonville, Oregon for Avamere at Three Fountains based on available NPPES addresses.
Is this NPI for an individual or an organization?
This listing corresponds to an Organization.

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