Individual provider Active NPI

Jennifer T Bowman

  • Audiologist
  • Portland, OR
National Provider Identifier
1063579969
Registry record updated Aug 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
023305 Issued in OR
Practice address
11390 SE 82ND Ave
Ste 801
Portland, OR 97086-7637
Phone
(503) 653-5004
Fax
(503) 794-0531
NPI assigned
Jan 2, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 023305 OR Primary

Addresses

Primary practice location

11390 SE 82ND Ave
Ste 801
Portland, OR 97086-7637

Mailing address

5000 Cheshire Pkwy N
Plymouth, MN 55446-4103
Phone (188) 833-3915

Other names 1

  • Jennifer Patrice Tomlin Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100504000691 OR Practitioner - Qualified Audiologist 1850393489 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MD24830ORMDPsychiatry Physician
023305ORMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Sep 1, 2013 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Sep 1, 2013 Accepting new patients

Locations

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

9427 SW Barnes Rd
Portland, OR 97225
Phone (503) 203-2040

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314748800000",
    "number": "1063579969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 CHESHIRE PKWY N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554464103",
            "telephone_number": "188-833-3915",
            "fax_number": "763-268-4353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11390 SE 82ND AVE",
            "address_2": "STE 801",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "970867637",
            "telephone_number": "503-653-5004",
            "fax_number": "503-794-0531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOWMAN",
        "first_name": "JENNIFER",
        "middle_name": "T",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-02",
        "last_updated": "2011-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "OR",
            "license": "023305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "TOMLIN",
            "middle_name": "PATRICE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.