NPIMap

Individual provider Active NPI

Jennifer Marie Wilson, FNP-C

  • Family Nurse Practitioner
  • Albany, OR
National Provider Identifier
1104197458
Registry record updated Nov 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
201250109NP Issued in OR
Practice address
1700 Geary St SE
Albany, OR 97322-6842
Phone
(541) 812-5500
NPI assigned
Jan 18, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 201250109NP OR Primary

Addresses

Primary practice location

1700 Geary St SE
Albany, OR 97322-6842

Mailing address

PO Box 1188
Corvallis, OR 97339-1188

Other identifiers 1

IdentifierTypeStateIssuer
500656964MedicaidOR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jwilson156803@samhealth.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20130423000317 OR Practitioner - Nurse Practitioner 5890931646 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Oregon Health Sciences University School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Albany General HospitalGroup PAC ID 9931097987, 191 clinicians

Practice addresses (Care Compare)

1700 Geary St SE
Suite 400
Albany, OR 97322-6842
Phone (541) 812-5500

Hospital & facility affiliations

  • Samaritan Albany General Hospital Hospital, Albany, OR, CCN 380022
  • Good Samaritan Regional Medical Center Hospital, Corvallis, OR, CCN 380014

Merit-based Incentive Payment System (MIPS)

Final score
91.14 of 100Reported as group
Quality
85.78
Promoting interoperability
100
Improvement activities
40
Cost
78.31

Merit-based Incentive Payment System (MIPS)

Final score
94.37 of 100Reported as group
Quality
92.31
Promoting interoperability
100
Improvement activities
40
Cost
80.9

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Good Samaritan Hospital Corvallis CurrentSince Sep 1, 2018 Accepting new patients
Mid-Valley Healthcare, Inc. CurrentSince Sep 1, 2018 Accepting new patients
Albany General Hospital Current Accepting new patients
Albany General Hospital CurrentSince Sep 1, 2018 Accepting new patients
Good Samaritan Hospital Corvallis CurrentSince Sep 1, 2018 Accepting new patients
Mid-Valley Healthcare Inc Current Accepting new patients
Albany General Hospital CurrentSince Sep 1, 2018 Accepting new patients
Good Samaritan Hospital Corvallis Current Accepting new patients
Mid-Valley Healthcare Inc CurrentSince Sep 1, 2018 Accepting new patients

Locations

1700 Geary St SE
Albany, OR 97322
Phone (541) 812-5500

705 Elm St SW
Ste 200
Albany, OR 97321
Phone (541) 812-4850

1700 Geary St SE
Ste 400
Albany, OR 97322
Phone (541) 812-5500

5234 SW Philomath Blvd
Corvallis, OR 97333
Phone (541) 768-4970

3600 NW Samaritan Dr
Ste 227
Corvallis, OR 97330
Phone (541) 768-1261

444 NW Elks Dr
Corvallis, OR 97330
Phone (541) 754-1256

35 Mullins Dr
Ste 2
Lebanon, OR 97355
Phone (541) 451-7915

325 Park St
Lebanon, OR 97355
Phone (541) 451-7200

Interoperability endpoints

  • Direct secure messaging: jwilson156803@samhealth.direct-ci.com

Organizations & group practices 9

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 38

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1326844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604361600000",
    "number": "1104197458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1188",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973391188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 GEARY ST SE",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973226842",
            "telephone_number": "541-812-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JENNIFER",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-18",
        "last_updated": "2020-11-03",
        "certification_date": "2020-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "201250109NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500656964",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jwilson156803@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "1700 Geary St SE",
            "city": "Albany",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973226842",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Albany, OR

Sources for this page

Verify at the official NPI Registry.