Active NPI
Jennifer L Micek, DO
- Family Medicine Physician
- Corvallis, OR
National Provider Identifier
1063485423
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- DO25970
- Practice address
- 530 NW 27TH St
Corvallis, OR 97330-5223 - Phone
- (541) 766-6835
- Fax
- (541) 766-6186
- NPI assigned
- Feb 8, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | DO25970 | OR | Primary |
Addresses
Primary practice location
530 NW 27TH St
Corvallis, OR 97330-5223
Mailing address
530 NW 27TH St
Corvallis, OR 97330-5223
Phone (541) 766-6835
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 168395 | Medicaid | OR | |
| R103163 | Other | MEDICARE PART B |
Other names 1
- Jennifer Nitz
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190807003114 | OR | Order and Referring Only - Family Practice | 6204851652 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
Networks
- devoted network organization-83621310-88c0-4660-8f8d-b8ea8f4dc04e
- WA PPO C-SNP
Interoperability endpoints
- jmicek160228@direct.ochin.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139356800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1734480000000",
"number": "1063485423",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "530 NW 27TH ST",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973305223",
"telephone_number": "541-766-6835",
"fax_number": "541-766-6186"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "530 NW 27TH ST",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973305223",
"telephone_number": "541-766-6835",
"fax_number": "541-766-6186"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICEK",
"first_name": "JENNIFER",
"middle_name": "L",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-08",
"last_updated": "2024-12-18",
"certification_date": "2024-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "DO25970",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "168395",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PART B",
"identifier": "R103163",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JENNIFER",
"last_name": "NITZ",
"credential": "DO",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Corvallis, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2024; 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.