Individual provider Active NPI

Jessica Anne Hargadine

  • Advanced Practice Midwife
  • Gresham, OR
National Provider Identifier
1124851811
Registry record updated Oct 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
10031483 Issued in OR
Practice address
24850 SE Stark St Ste 200
Gresham, OR 97030-8320
Phone
(503) 491-9444
NPI assigned
Aug 20, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X 10031483
Advanced Practice Midwife 367A00000X 10031483 OR Primary

Addresses

Primary practice location

24850 SE Stark St Ste 200
Gresham, OR 97030-8320

Mailing address

1416 C St
Washougal, WA 98671-2332
Phone (406) 498-2400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241021003643 OR Practitioner - Certified Nurse Midwife (CNM) 2769914357 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Clinics LLC CurrentSince Oct 15, 2024 Accepting new patients
Legacy Clinics LLC CurrentSince Oct 15, 2024 Accepting new patients
Legacy Mount Hood Medical Center Past Accepting new patients

Locations

24850 SE Stark St
Ste 200
Gresham, OR 97030
Phone (503) 491-9444

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

1919 NW Lovejoy St
Portland, OR 97209
Phone (503) 415-5600

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": "1724112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1124851811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1416 C ST",
            "city": "WASHOUGAL",
            "state": "WA",
            "postal_code": "986712332",
            "telephone_number": "406-498-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24850 SE STARK ST STE 200",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970308320",
            "telephone_number": "503-491-9444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARGADINE",
        "first_name": "JESSICA",
        "middle_name": "ANNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-20",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": null,
            "license": "10031483",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "OR",
            "license": "10031483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gresham, OR

Sources for this page

Verify at the official NPI Registry.