Individual provider Active NPI

Jennifer Ellen Slickers, M.D., MPH

  • Pediatrics Physician
  • Portland, OR
National Provider Identifier
1184839979
Registry record updated Feb 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD27805 Issued in OR
Practice address
19550 SE Stark St
Rockwood Medical Office
Portland, OR 97233-5792
Phone
(503) 669-3900
Fax
(503) 669-3998
NPI assigned
May 14, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD27805 OR Primary

Addresses

Primary practice location

19550 SE Stark St
Rockwood Medical Office
Portland, OR 97233-5792

Mailing address

19550 SE Stark St
Rockwood Medical Office
Portland, OR 97233-5792
Phone (503) 669-3900

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE) Northwest Permanente PC

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070920000220 OR Practitioner - Pediatric MedicinePractitioner - Nephrology 6305930405 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Mar 31, 2015 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Pediatrics Current Accepting new patients
Kaiser Foundation Hospitals Past Accepting new patients

Locations

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

2875 NE Stucki Ave
Hillsboro, OR 97124
Phone (866) 280-0511

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

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

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

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": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643673600000",
    "number": "1184839979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19550 SE STARK ST",
            "address_2": "ROCKWOOD MEDICAL OFFICE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972335792",
            "telephone_number": "503-669-3900",
            "fax_number": "503-669-3998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19550 SE STARK ST",
            "address_2": "ROCKWOOD MEDICAL OFFICE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972335792",
            "telephone_number": "503-669-3900",
            "fax_number": "503-669-3998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SLICKERS",
        "first_name": "JENNIFER",
        "middle_name": "ELLEN",
        "name_prefix": "Dr.",
        "credential": "M.D., MPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-14",
        "last_updated": "2022-02-01",
        "certification_date": "2022-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD27805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Northwest Permanente PC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "2875 NE Stucki Ave",
            "city": "Hillsboro",
            "state": "OR",
            "country_code": "US",
            "postal_code": "971245806",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.