Individual provider Active NPI

Jason Marc Deville, D.O.

  • Nephrology Physician
  • Spokane, WA
National Provider Identifier
1255440459
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
OP60007005 Issued in WA
Practice address
605 E Holland Ave
Suite 101
Spokane, WA 99218-2225
Phone
(509) 838-2531
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X DO26307 OR
Nephrology Physician 207RN0300X OP60007005 WA Primary
Nephrology Physician 207RN0300X O-0476 ID

Addresses

Primary practice location

605 E Holland Ave
Suite 101
Spokane, WA 99218-2225

Mailing address

PO Box 3649
Spokane, WA 99220-3649
Phone (509) 838-2531

Other identifiers 1

IdentifierTypeStateIssuer
8510828MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20070321000098 OR Practitioner - NephrologyPractitioner - Internal Medicine 1557464062 Reassigns benefits to 1 organization
I20080730000170 WA Practitioner - NephrologyPractitioner - Internal Medicine 1557464062 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Arizona College of Osteopathic Medicine Mid Western University, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

10100 SE Sunnyside Rd
Clackamas, OR 97015-8970
Phone (800) 813-2000

10180 SE Sunnyside Rd
Clackamas, OR 97015-8970
Phone (800) 813-2000

9900 SE Sunnyside Rd
Clackamas, OR 97015-9777
Phone (800) 813-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
O-0476IDMDNephrology Physician
OP60007005WAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest Internal Medicine CurrentSince Mar 18, 2010 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Mar 18, 2010 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Internal Medicine CurrentSince Mar 18, 2010 Accepting new patients
Providence Health & Services - Oregon Internal Medicine Past Accepting new patients

Locations

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

6902 SE Lake Rd
Ste 100
Portland, OR 97267
Phone (503) 774-3350

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 4

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 1

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": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1255440459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3649",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992203649",
            "telephone_number": "509-838-2531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 E HOLLAND AVE",
            "address_2": "SUITE 101",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992182225",
            "telephone_number": "509-838-2531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVILLE",
        "first_name": "JASON",
        "middle_name": "MARC",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "DO26307",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "WA",
            "license": "OP60007005",
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "ID",
            "license": "O-0476",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8510828",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

Verify at the official NPI Registry.