NPIMap

Individual provider Active NPI

Jenny Lupovici Wilson, M.D.

  • Neurology with Special Qualifications in Child Neurology Physician
  • Portland, OR
National Provider Identifier
1205094406
Registry record updated May 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
License
MD162292 Issued in OR
Practice address
707 SW Gaines St
Portland, OR 97239-2901
Phone
(503) 494-9113
NPI assigned
May 26, 2008
Last updated
May 21, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X MD162292 OR Primary
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X MD441944 PA

Addresses

Primary practice location

707 SW Gaines St
Portland, OR 97239-2901

Mailing address

707 SW Gaines St
Portland, OR 97239-2901
Phone (503) 804-6824

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
I20130730000887 OR Practitioner - Pediatric Medicine 3971744129 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Stanford University School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Professional ServicesGroup PAC ID 4880760107, 1,683 clinicians

Practice addresses (Care Compare)

15700 SW Greystone CT
Beaverton, OR 97006-6011
Phone (503) 494-3442

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone (503) 494-8311

Merit-based Incentive Payment System (MIPS)

Final score
99.11 of 100Reported as apm
Quality
84.29
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD441944PAMDNeurology with Special Qualifications in Child Neurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Professional Services CurrentSince Sep 3, 2013 Accepting new patients
Shriners Hospitals for Children CurrentSince Aug 28, 2023 Accepting new patients
Shriners Hospitals for Children Current Accepting new patients
University Professional Services Current Accepting new patients
Shriners Hospitals for Children CurrentSince Aug 28, 2023 Accepting new patients
University Professional Services CurrentSince Sep 3, 2013 Accepting new patients
University Professional Services Past Accepting new patients
Shriners Hospitals for Children Past Accepting new patients

Locations

15700 SW Greystone Ct
Beaverton, OR 97006
Phone (503) 203-1000

750 Murphy Rd
Medford, OR 97504
Phone (541) 608-4096

3101 SW Sam Jackson Park Rd
Portland, OR 97239
Phone (503) 221-3424

3181 SW Sam Jackson Park Rd
Portland, OR 97239
Phone (503) 494-5674

707 SW Gaines St
Portland, OR 97239
Phone (503) 492-2709

Interoperability endpoints

  • Direct secure messaging: jwilsonmd82156@direct.ohsu.edu

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1211760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369094400000",
    "number": "1205094406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 SW GAINES ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972392901",
            "telephone_number": "503-804-6824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 SW GAINES ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972392901",
            "telephone_number": "503-494-9113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JENNY",
        "middle_name": "LUPOVICI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-26",
        "last_updated": "2013-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "OR",
            "license": "MD162292",
            "primary": true
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "PA",
            "license": "MD441944",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.