Jennifer Shannon Haag, AGPCNP
Individual provider Active NPI Gerontology Nurse Practitioner · Seaside, OR
NPI 1285095398 · NPPES record last updated Jan 14, 2021
Key facts
- NPI
- 1285095398
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Gerontology Nurse Practitioner 363LG0600X
- License
- 201707705NP-PP (OR)
- Practice address
- 727 S Wahanna Rd
Seaside, OR 97138-7735 - Phone
- (503) 717-7060
- NPI assigned
- Mar 16, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Providence Health and Services Oregon
Practice addresses (Care Compare)
725 S Wahanna Rd
Seaside, OR 97138-7735
Phone (503) 717-7000
727 S Wahanna Rd
Seaside, OR 97138-7735
Phone (503) 717-7000
Hospital & facility affiliations
- Providence Seaside Hospital
- Novant Health New Hanover Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180214001079 | OR | Practitioner - Nurse Practitioner | 9133411671 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0024172937 | VA | MD | Adult Health Nurse Practitioner |
| 201707705NP-PP | OR | MD | Gerontology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Providence Health & Services Oregon | Current |
Accepting new patients | |
| Providence Health & Services Oregon | Current |
Accepting new patients | |
| Wimahl Family Clinic, PC | Current |
Accepting new patients | |
| Providence Health & Services Oregon | Current |
Accepting new patients | |
| Providence Health & Services Oregon | Current | Accepting new patients | |
| Providence Health & Services - Oregon | Current |
Accepting new patients | |
| Providence Health & Services Oregon | Current |
Accepting new patients | |
| Providence Health & Services Oregon | Past | Accepting new patients |
Locations
2158 Exchange St
Ste 209
Astoria, OR 97103
Phone (503) 338-2993
441 30th St
Astoria, OR 97103
Phone (503) 338-2993
646 16th St
Astoria, OR 97103
Phone (503) 325-0313
12345 SW Horizon Blvd
Ste 57
Beaverton, OR 97007
Phone (503) 216-8820
727 S Wahanna Rd
Seaside, OR 97138
Phone (503) 717-7000
725 S Wahanna Rd
Seaside, OR 97138
Phone (503) 717-7000
12442 SW Scholls Ferry Rd
Ste 100
Tigard, OR 97223
Phone (503) 215-9900
171 S Highway 101
Warrenton, OR 97146
Phone (503) 717-7000
113 S Highway 101
Warrenton, OR 97146
Phone (503) 861-6500
Interoperability endpoints
- jhaag874131@oc.providencedirect.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 0024172937 | VA | |
| Adult Health Nurse Practitioner | 363LA2200X | 0024172937 | VA | |
| Gerontology Nurse Practitioner | 363LG0600X | 201707705NP-PP | OR | Yes |
Addresses
Primary practice location
727 S Wahanna Rd
Seaside, OR 97138-7735
Mailing address
PO Box 3397
Portland, OR 97208-3397
Other practice location 1
8640 Sudley Rd
Suite 303
Manassas, VA 20110-4420
Phone (703) 361-7778
Other names
- Jennifer Shannon Raywood
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jhaag874131@oc.providencedirect.org | ||
| Direct Messaging Address | jhaag325839@direct.novanthealth.org |
Other providers in Seaside, OR
- Cynthia Machelle Gonzalez
- Lindsay Diane Goodman
- Dominique Greco
- Gary M Greenberg
- Laura Ann Gronholm
- Debra Dunaway Hall
- April Hand
- Kristine Ruth Hansen
- Rogue Hartman
- Lynne M. Hedbloom
All providers in Seaside, OR · Gerontology Nurse Practitioner in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 14, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.