Jordan A Phillips, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

PG225177 Issued in OR

Practice address

4104 SE 82ND Ave Ste 250
Portland, OR 97266-2954

Phone

(503) 215-9850

NPI assigned

Apr 10, 2025

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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

{
    "created_epoch": "1744243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744243200000",
    "number": "1336934470",
    "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": "503-215-6494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4104 SE 82ND AVE STE 250",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972662954",
            "telephone_number": "503-215-9850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "JORDAN",
        "middle_name": "A",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-04-10",
        "last_updated": "2025-04-10",
        "certification_date": "2025-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "PG225177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Lee Phillips, R.T. (R) (ARRT)
• Jeffrey Eric Phillips
• Jennifer Phillips, RNFA
• Jennifer Ashley Phillips III
• Jerry Phillips
• Julia Aretha Phillips, LCSW
• Kailee Payton Phillips, ND
• Katharine Brandt Phillips, PT
• La Treca Phillips
• Matt Glenn Phillips

• Family Medicine Physician in Portland, OR
• Providers in Portland, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.