Individual provider Active NPI

Jennifer S Lin, MD

  • Internal Medicine Physician
  • Portland, OR
National Provider Identifier
1114996485
Registry record updated Sep 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD26772 Issued in OR
Practice address
1700 NE 102ND Ave
Portland, OR 97220-3804
Phone
(503) 813-2000
NPI assigned
Mar 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD00043344 WA
Internal Medicine Physician 207R00000X MD26772 OR Primary

Addresses

Primary practice location

1700 NE 102ND Ave
Portland, OR 97220-3804

Mailing address

1700 NE 102ND Ave
Portland, OR 97220-3804
Phone (503) 813-2000

Other identifiers 5

IdentifierTypeStateIssuer
P00364819OtherRR MEDICARE
8393126MedicaidWA
8940783OtherWACRIME VICTIMS
005813MedicaidOR
0206291OtherWALABOR & IND.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, OR2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20040602001122 WA Practitioner - Internal Medicine 0143202390 Reassigns benefits to 1 organization
I20070823000927 OR Practitioner - Internal Medicine 0143202390 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
New York University School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kaiser Foundation Health Plan of the NorthwestGroup PAC ID 5799688230, 1,805 clinicians

Practice addresses (Care Compare)

10100 SE Sunnyside Rd
Clackamas, OR 97015-8970
Phone (800) 813-2000

10180 SE Sunnyside Rd
Clackamas, OR 97015-8970
Phone (800) 813-2000

1700 NE 102ND Ave
Portland, OR 97220-3804
Phone (800) 813-2000

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

State licenses

LicenseStateTypeSpecialty
MD00043344WAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Oct 24, 2011 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Internal Medicine CurrentSince Jul 8, 2019 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Internal Medicine CurrentSince Oct 24, 2011 Accepting new patients

Locations

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

1700 NE 102nd Ave
Portland, OR 97220
Phone (866) 279-4581

1700 NE 102nd Ave
Ofc
Portland, OR 97220

500 NE Multnomah St
Portland, OR 97232
Phone (503) 813-4939

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

1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801

1615 Delaware St
Longview, WA 98632
Phone (360) 363-4818

7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000

400 NE Mother Joseph Pl
Vancouver, WA 98664
Phone (360) 514-2000

Organizations & group practices 3

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": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442188800000",
    "number": "1114996485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 NE 102ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972203804",
            "telephone_number": "503-813-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 NE 102ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972203804",
            "telephone_number": "503-813-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIN",
        "first_name": "JENNIFER",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-17",
        "last_updated": "2015-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD00043344",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD26772",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00364819",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8393126",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRIME VICTIMS",
            "identifier": "8940783",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005813",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & IND.",
            "identifier": "0206291",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.