Individual provider Active NPI

Jennifer Catherine O'Connor, DO

  • Obstetrics & Gynecology Physician
  • Vancouver, WA
National Provider Identifier
1083694376
Registry record updated Dec 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
OP00001989 Issued in WA
Practice address
2101 NE 139TH St
Ste 350
Vancouver, WA 98686-2309
Phone
(360) 256-4060
Fax
(360) 256-0103
NPI assigned
Jan 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X OP00001989 WA Primary

Addresses

Primary practice location

2101 NE 139TH St
Ste 350
Vancouver, WA 98686-2309

Mailing address

2101 NE 139TH St
Ste 350
Vancouver, WA 98686-2309
Phone (360) 256-4060

Other practice location 1

505 NE 87th Ave Ste 160
Vancouver, WA 98664-1965
Phone (360) 514-1060

Other identifiers 1

IdentifierTypeStateIssuer
8253957MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050919000104 WA Practitioner - Obstetrics/Gynecology 4082647128 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
PeacehealthGroup PAC ID 8820178288, 245 clinicians

Practice addresses (Care Compare)

505 NE 87TH Ave
Suite 160
Vancouver, WA 98664-1965
Phone (360) 514-1060

Hospital & facility affiliations

  • Peacehealth Southwest Medical Cente Hospital, Vancouver, WA, CCN 500050

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OP00001989WAMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Peacehealth Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: joconnor64259@direct.peacehealth.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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1137715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638921600000",
    "number": "1083694376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 NE 139TH ST",
            "address_2": "STE 350",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986862309",
            "telephone_number": "360-256-4060",
            "fax_number": "360-256-0103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 NE 139TH ST",
            "address_2": "STE 350",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986862309",
            "telephone_number": "360-256-4060",
            "fax_number": "360-256-0103"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "505 NE 87th Ave Ste 160",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986641965",
            "country_code": "US",
            "telephone_number": "360-514-1060",
            "fax_number": "360-514-1065",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "O'CONNOR",
        "first_name": "JENNIFER",
        "middle_name": "CATHERINE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-20",
        "last_updated": "2021-12-08",
        "certification_date": "2021-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "WA",
            "license": "OP00001989",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8253957",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.