NPIMap

Individual provider Active NPI

Jerrold L Snow, DO

  • Family Medicine Physician
  • Milwaukie, OR
National Provider Identifier
1053307645
Registry record updated Jun 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
D017285 Issued in OR
Practice address
6564 SE Lake Rd Ste 200
Milwaukie, OR 97222
Phone
(503) 908-5880
Fax
(888) 475-8729
NPI assigned
Sep 20, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 22, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X D017285 OR Primary

Addresses

Primary practice location

6564 SE Lake Rd Ste 200
Milwaukie, OR 97222

Mailing address

6564 SE Lake Rd Ste 200
Milwaukie, OR 97222-2237
Phone (503) 908-5880

Other identifiers 1

IdentifierTypeStateIssuer
033840MedicaidOR

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
I20080205000136 OR Practitioner - Family Practice 7810079472 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Jerrold L Snow LLCGroup PAC ID 2062597404, 3 clinicians

Practice addresses (Care Compare)

6564 SE Lake Rd
Suite 200
Milwaukie, OR 97222-2237
Phone (503) 908-5880

Hospital & facility affiliations

  • Providence Milwaukie Hospital Hospital, Milwaukie, OR, CCN 380082
  • Legacy Mount Hood Medical Center Hospital, Gresham, OR, CCN 380025
  • Providence Willamette Falls Medical Center Hospital, Oregon City, OR, CCN 380038

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10
Removal of the uterus1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D017285ORMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Woodstock Family Medicine LLC Family Medicine Current Accepting new patients
Jerrold L Snow LLC Family Medicine CurrentSince Dec 11, 2007 Accepting new patients
West Valley Hospital Pharmacy Past Accepting new patients
Salem Health West Valley PastSince Mar 3, 2011 Accepting new patients
Salem Radiology Consultants PC Past Accepting new patients
Valley View Medical Clinic PC Family Medicine Past Accepting new patients

Locations

6564 SE Lake Rd
Ste 200
Portland, OR 97222
Phone (503) 477-4343

Interoperability endpoints

  • Direct secure messaging: jerrold.snow.1@18772.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/18772/brand/1/csg/1/fhir/r4
  • FHIR API: https://api.platform.athenahealth.com/16993/brand/1/csg/1/fhir/r4

Organizations & group practices 6

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

Hospital & facility affiliations 4

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": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655856000000",
    "number": "1053307645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6564 SE LAKE RD STE 200",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972222237",
            "telephone_number": "503-908-5880",
            "fax_number": "888-475-8729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6564 SE LAKE RD STE 200",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "97222",
            "telephone_number": "503-908-5880",
            "fax_number": "888-475-8729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SNOW",
        "first_name": "JERROLD",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-20",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "D017285",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "033840",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukie, OR

Sources for this page

Verify at the official NPI Registry.