NPIMap

Individual provider Active NPI

Jennifer M Slack, MD

  • Internal Medicine Physician
  • Portland, OR
National Provider Identifier
1043401813
Registry record updated Jul 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD27695 Issued in OR
Practice address
501 N Graham St Ste 100
Portland, OR 97227-1650
Phone
(503) 249-5780
Fax
(503) 249-5788
NPI assigned
Aug 7, 2007
Last updated
Jul 24, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD27695 OR Primary

Addresses

Primary practice location

501 N Graham St Ste 100
Portland, OR 97227-1650

Mailing address

1411 SW Morrison St Ste 200
Portland, OR 97205-1945
Phone (503) 242-9850

Other practice location 1

1350 NE 122nd Ave
Portland, OR 97230-2011
Phone (503) 408-7010

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071121000066 OR Practitioner - Internal Medicine 1355439563 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Arizona College of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Portland Adventist Medical CenterGroup PAC ID 3274908819, 273 clinicians

Practice addresses (Care Compare)

1350 NE 122ND Ave
Portland, OR 97230-2011
Phone (503) 408-7010

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD27695ORMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Emanuel Hospital & Health Center CurrentSince Jan 30, 2017 Accepting new patients
Portland Adventist Medical Center CurrentSince Jul 15, 2024 Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Jan 30, 2017 Accepting new patients
Legacy Clinics LLC CurrentSince Apr 1, 2020 Accepting new patients
Portland Adventist Medical Center Internal Medicine CurrentSince Jan 29, 2023 Accepting new patients
Legacy Emanuel Hospital & Health Center Current Accepting new patients
Legacy Clinics LLC Internal Medicine CurrentSince Apr 1, 2020 Accepting new patients
Walla Walla General Hospital Past Accepting new patients

Locations

10151 SE Sunnyside Rd
Ste 100
Clackamas, OR 97015
Phone (503) 659-0880

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

1350 NE 122nd Ave
Portland, OR 97230
Phone (503) 408-7008

1350 NE 122nd Ave
Ste 100
Portland, OR 97230
Phone (503) 408-7010

2222 NW Lovejoy St
Ste 505
Portland, OR 97210
Phone (503) 226-4091

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

501 N Graham St
Ste 100
Portland, OR 97227
Phone 5032429850209

500 N Columbia River Hwy
Ste 6
Saint Helens, OR 97051
Phone (503) 366-5101

19250 SW 65th Ave
Ste 110
Tualatin, OR 97062
Phone (503) 692-1205

Networks

  • WA PPO C-SNP
  • devoted network organization-83621310-88c0-4660-8f8d-b8ea8f4dc04e

Interoperability endpoints

  • Direct secure messaging: jslack174906@direct.ohsu.edu

Organizations & group practices 8

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.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1186444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721779200000",
    "number": "1043401813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 SW MORRISON ST STE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972051945",
            "telephone_number": "503-242-9850",
            "fax_number": "503-279-8157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 N GRAHAM ST STE 100",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972271650",
            "telephone_number": "503-249-5780",
            "fax_number": "503-249-5788"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1350 NE 122nd Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972302011",
            "country_code": "US",
            "telephone_number": "503-408-7010",
            "fax_number": "503-408-7035",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SLACK",
        "first_name": "JENNIFER",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-07",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD27695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.