Individual provider Active NPI

Jonathan Marquett, OD

  • Optometrist
  • Portland, OR
National Provider Identifier
1154005403
Registry record updated Aug 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
ATI4679 Issued in OR
Practice address
10819 SE Stark St
Portland, OR 97216-3161
Phone
(503) 255-2291
Fax
(503) 252-1797
NPI assigned
Jun 14, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X ATI4679 OR Primary

Addresses

Primary practice location

10819 SE Stark St
Portland, OR 97216-3161

Mailing address

10819 SE Stark St
Portland, OR 97216-3161
Phone (503) 255-2291

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: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240621002979 OR Practitioner - Optometry 5193268845 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eye Health Northwest PCGroup PAC ID 9234039926, 72 clinicians

Practice addresses (Care Compare)

11086 SE Oak St
Milwaukie, OR 97222-6692
Phone (503) 656-4221

24601 SE Stark St
Troutdale, OR 97060-3355
Phone (503) 255-2291

5050 NE Hoyt St
Suite 445
Portland, OR 97213-2984
Phone (503) 231-0166

6701 NE Glisan St
Portland, OR 97213-5553
Phone (503) 255-2291

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4679ORMDClinical Social Worker
ATI4679ORMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Eye Health Northwest P.C. Optometrist CurrentSince Aug 5, 2024 Accepting new patients
Eye Health Northwest, PC CurrentSince Aug 5, 2024 Accepting new patients

Locations

6701 NE Glisan St
Portland, OR 97213
Phone (503) 255-2291

11086 SE Oak St
Portland, OR 97222
Phone (503) 557-2020

5050 NE Hoyt St
Ste 445
Portland, OR 97213
Phone (503) 231-0166

10819 SE Stark St
Portland, OR 97216
Phone (503) 255-2291

Interoperability endpoints

  • Direct secure messaging: jonathan.marquett@direct.ehnpc.nextgenshare.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1686700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722470400000",
    "number": "1154005403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10819 SE STARK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972163161",
            "telephone_number": "503-255-2291",
            "fax_number": "503-252-1797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10819 SE STARK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972163161",
            "telephone_number": "503-255-2291",
            "fax_number": "503-252-1797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARQUETT",
        "first_name": "JONATHAN",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-14",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "ATI4679",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.