Active NPI
Jordyn R Ellis, CHW
- Community Health Worker
- Salem, OR
National Provider Identifier
1093671885
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 115728
- Practice address
- 608 Lancaster Dr SE
Salem, OR 97317-5643 - Phone
- (503) 877-1995
- Fax
- (888) 990-1352
- NPI assigned
- Dec 24, 2025
- 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 |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 115728 | OR | Primary |
Addresses
Primary practice location
608 Lancaster Dr SE
Salem, OR 97317-5643
Mailing address
608 Lancaster Dr SE
Salem, OR 97317-5643
Phone (503) 877-1995
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 115728 | OR | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1766534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1772668800000",
"number": "1093671885",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "608 LANCASTER DR SE",
"city": "SALEM",
"state": "OR",
"postal_code": "973175643",
"telephone_number": "503-877-1995",
"fax_number": "888-990-1352"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "608 LANCASTER DR SE",
"city": "SALEM",
"state": "OR",
"postal_code": "973175643",
"telephone_number": "503-877-1995",
"fax_number": "888-990-1352"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "JORDYN",
"middle_name": "R",
"credential": "CHW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-12-24",
"last_updated": "2026-03-05",
"certification_date": "2026-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "OR",
"license": "115728",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.