Active NPI
Jean M Brown, PA-C
- Physician Assistant
- Bend, OR
National Provider Identifier
1003873142
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA01237
- Practice address
- 2500 NE Neff Rd
Bend, OR 97701-6015 - Phone
- (541) 388-1636
- Fax
- (541) 388-1719
- NPI assigned
- May 1, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 569-023 | WI | |
| Surgical Physician Assistant | 363AS0400X | 569-023 | WI | |
| Physician Assistant | 363A00000X | PA01237 | OR | Primary |
Addresses
Primary practice location
2500 NE Neff Rd
Bend, OR 97701-6015
Mailing address
PO Box 5579
Bend, OR 97708-5579
Phone (541) 388-1636
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00834460 | Other | OR | MEDICARE RAILROAD |
| 2908 | Other | WI | DEAN HEALTH INSURANCE |
| 42923300 | Medicaid | WI | |
| 970010935 | Other | WI | RAILROAD MEDICARE |
| 500605405 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA01237 | OR | MD | Physician Assistant |
| 569-023 | WI | MD | Physician Assistant |
Interoperability endpoints
- jbrown17866@secure.stcharleshealthcare.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146441600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433116800000",
"number": "1003873142",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5579",
"city": "BEND",
"state": "OR",
"postal_code": "977085579",
"telephone_number": "541-388-1636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 NE NEFF RD",
"city": "BEND",
"state": "OR",
"postal_code": "977016015",
"telephone_number": "541-388-1636",
"fax_number": "541-388-1719"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROWN",
"first_name": "JEAN",
"middle_name": "M",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-01",
"last_updated": "2015-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WI",
"license": "569-023",
"primary": false
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "WI",
"license": "569-023",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OR",
"license": "PA01237",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "00834460",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEAN HEALTH INSURANCE",
"identifier": "2908",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "42923300",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "970010935",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500605405",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.