Jill Marie Gordanier, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

LD-D-10194419 Issued in OR

Practice address

1508 Division St Ste 15
Oregon City, OR 97045-1583

Phone

(503) 692-3750

Fax

(503) 691-2324

NPI assigned

May 19, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1621382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637539200000",
    "number": "1316511751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "847 NE 19TH AVE STE 300",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322686",
            "telephone_number": "503-963-2801",
            "fax_number": "503-963-2825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1508 DIVISION ST STE 15",
            "city": "OREGON CITY",
            "state": "OR",
            "postal_code": "970451583",
            "telephone_number": "503-692-3750",
            "fax_number": "503-691-2324"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19250 SW 90th Ave",
            "address_purpose": "LOCATION",
            "city": "Tualatin",
            "state": "OR",
            "postal_code": "970627585",
            "country_code": "US",
            "telephone_number": "503-692-3750",
            "fax_number": "503-691-2324",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "879 N Providence Dr",
            "address_purpose": "LOCATION",
            "city": "Newberg",
            "state": "OR",
            "postal_code": "971327563",
            "country_code": "US",
            "telephone_number": "503-692-3750",
            "fax_number": "503-691-2324",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDANIER",
        "first_name": "JILL",
        "middle_name": "MARIE",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-19",
        "last_updated": "2021-11-22",
        "certification_date": "2021-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "OR",
            "license": "LD-D-10194419",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2178242",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500793387",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "referringgso@orclinic.direct-ci.net",
            "affiliation": "Y",
            "affiliationName": "The Oregon Clinic PC",
            "address_1": "19250 SW 90th Ave",
            "city": "Tualatin",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970627585",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Janet Gomez Soumphonpackdy
• Melissa Gomez
• Adrian Goncerzewicz
• Jeanine Marie Goodwin, QMHP
• Tiffany Goodwin
• Shira Ann Gordon-Hite
• Joanne Lisa Gordon, M.S., P.T., N.D.
• Rebecca Grace Gordon, MD
• Andrea L Gore, CDP
• Jennifer Price Gould, RN

• Registered Dietitian in Oregon City, OR
• Providers in Oregon City, OR by specialty
• Registered Dietitian in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.