Jennifer Kay Bane, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

173635 Issued in OR

Practice address

511 SW 10TH Ave
Suite 1301
Portland, OR 97205-2732

Phone

(503) 228-0155

Fax

(503) 226-8342

NPI assigned

May 12, 2010

Last updated

Dec 13, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Allergy Clinic LLC

  • Allergy Physician
  • Portland, OR
  • NPI 1679790604
  NPD (past)
• Heritage Family Medicine

  dba Heritage Senior Care

  • Family Medicine Physician
  • Fort Collins, CO
  • NPI 1669535118
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1273622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576195200000",
    "number": "1033437298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 SW 10TH AVE STE 1301",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052714",
            "telephone_number": "503-228-0155",
            "fax_number": "503-226-8342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 SW 10TH AVE",
            "address_2": "SUITE 1301",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052732",
            "telephone_number": "503-228-0155",
            "fax_number": "503-226-8342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANE",
        "first_name": "JENNIFER",
        "middle_name": "KAY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-12",
        "last_updated": "2019-12-13",
        "certification_date": "2019-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10004564",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "173635",
            "primary": true
        },
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "OR",
            "license": "PA173635",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2010430",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Linda A Banchini, NUTRITIONIST
• Ginger Bandeen
• Krishna Hecht Bandi, M.D.
• Janelle Bandurraga-Rice, LDM
• James Edward Bane, MD
• Aaron Banen
• Adrian Olaf Banerji
• Leigh Banfill, LCSW
• Amber Mia Bang, RN
• Martin Bang, LAC

• Medical Physician Assistant in Portland, OR
• Providers in Portland, OR by specialty
• Medical Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.