NPIMap

Individual provider Active NPI

Jayrus Francis Simbulan Soliman, M.D.

  • Internal Medicine Physician
  • Medford, OR
National Provider Identifier
1245598416
Registry record updated May 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD171549 Issued in OR
Practice address
965 Ellendale Dr
Medford, OR 97504-8215
Phone
(541) 732-6000
Fax
(541) 732-6005
NPI assigned
Apr 25, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2022

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 099206 OH
Internal Medicine Physician 207R00000X MD171549 OR Primary

Addresses

Primary practice location

965 Ellendale Dr
Medford, OR 97504-8215

Mailing address

PO Box 3158
Portland, OR 97208-3158
Phone (541) 732-6000

Other identifiers 1

IdentifierTypeStateIssuer
500689075MedicaidOR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jsoliman551682@oc.providencedirect.org

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
I20150827001052 OR Practitioner - Internal Medicine 5496905713 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

940 Royal Ave
Medford, OR 97504-6194

965 Ellendale Dr
Medford, OR 97504-8215
Phone (541) 732-6000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
099206OHMDInternal Medicine Physician
MD171549ORMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Oregon CurrentSince Oct 1, 2015 Accepting new patients
Providence Health & Services Oregon Internal Medicine Current Accepting new patients
Providence Health & Services - Oregon CurrentSince Oct 1, 2015 Accepting new patients

Locations

1698 E McAndrews Rd
Ste 400
Medford, OR 97504
Phone (541) 732-6000

940 Royal Ave
Unit 350
Medford, OR 97504
Phone (541) 732-7460

965 Ellendale Dr
Medford, OR 97504
Phone (541) 732-6000

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1335312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651536000000",
    "number": "1245598416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "541-732-6000",
            "fax_number": "541-732-6005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "965 ELLENDALE DR",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048215",
            "telephone_number": "541-732-6000",
            "fax_number": "541-732-6005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOLIMAN",
        "first_name": "JAYRUS FRANCIS",
        "middle_name": "SIMBULAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-25",
        "last_updated": "2022-05-03",
        "certification_date": "2022-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "099206",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD171549",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500689075",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jsoliman551682@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "965 Ellendale Dr",
            "city": "Medford",
            "state": "OR",
            "country_code": "US",
            "postal_code": "975048215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.