NPIMap

Individual provider Active NPI

Jennifer G Engstrom, MD

  • Family Medicine Physician
  • Marysville, WA
National Provider Identifier
1063675346
Registry record updated May 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD60021576 Issued in WA
Practice address
11603 State Ave
Ste G
Marysville, WA 98271-8465
Phone
(360) 658-6800
Fax
(360) 658-6819
NPI assigned
Jul 7, 2008
Last updated
May 18, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2021

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 MD60021576 WA Primary

Addresses

Primary practice location

11603 State Ave
Ste G
Marysville, WA 98271-8465

Mailing address

PO Box 3360
Portland, OR 97208-3360
Phone (866) 366-2983

Other identifiers 1

IdentifierTypeStateIssuer
MD60021576OtherWAWSL

Other names 1

  • Jennifer Ruth Grace Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jengstrom122207@wm.providencedirect.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20110531000753 WA Practitioner - Family Practice 0446437495 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Loma Linda University School of Dentistry, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

11603 State Ave
Suite G
Marysville, WA 98271-8465
Phone (360) 658-6800

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services- Washington CurrentSince Apr 14, 2011 Accepting new patients
Providence Health & Services-Washington Family Medicine CurrentSince Apr 14, 2011 Accepting new patients

Locations

1321 Colby Ave
Ofc
Everett, WA 98201
Phone (425) 261-4076

11603 State Ave
Ste G
Marysville, WA 98271
Phone (360) 658-6800

4112 Harbour Pointe Blvd SW
Ste 100
Mukilteo, WA 98275
Phone (425) 347-6330

Interoperability endpoints

  • Direct secure messaging: jengstrom122207@wm.providencedirect.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1215388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621296000000",
    "number": "1063675346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3360",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083360",
            "telephone_number": "866-366-2983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11603 STATE AVE",
            "address_2": "STE G",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982718465",
            "telephone_number": "360-658-6800",
            "fax_number": "360-658-6819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENGSTROM",
        "first_name": "JENNIFER",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-07",
        "last_updated": "2021-05-18",
        "certification_date": "2021-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60021576",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WSL",
            "identifier": "MD60021576",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jengstrom122207@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "11603 State Ave",
            "address_2": "STE G",
            "city": "Marysville",
            "state": "WA",
            "country_code": "US",
            "postal_code": "982718465",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "GRACE",
            "middle_name": "RUTH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Marysville, WA

Sources for this page

Verify at the official NPI Registry.