Jennifer L. Wrazen, M.D., FAAP
Individual provider Active NPI Pediatrics Physician · Waldport, OR
NPI 1366486532 · NPPES record last updated Nov 3, 2020
Key facts
- NPI
- 1366486532
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- MD21902 (OR)
- Practice address
- 920 SW Range Dr
Waldport, OR 97394-9634 - Phone
- (541) 563-3197
- NPI assigned
- Jun 16, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
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: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120203000765 | OR | Practitioner - Pediatric Medicine | 5799942694 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Samaritan Pacific Health Services, Inc | Current | Accepting new patients | |
| Samaritan Pacific Health Services Inc | Current |
Accepting new patients | |
| Samaritan Pacific Health Services, Inc | Current |
Accepting new patients | |
| Samaritan Pacific Health Services, Inc. | Current | Accepting new patients | |
| Samaritan Pacific Health Services, Inc. | Past |
Accepting new patients |
Locations
777 NW 9th St
Ste 102
Corvallis, OR 97330
Phone (541) 768-6769
930 SW Abbey St
Newport, OR 97365
Phone (541) 265-2244
920 SW Range Dr
Waldport, OR 97394
Phone (541) 563-3197
Interoperability endpoints
- jwrazen6279@samhealth.direct-ci.com
- jenifer.wrazen.d1.p1@direct.siletzhealthclinic.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD21902 | OR | Yes |
Addresses
Primary practice location
920 SW Range Dr
Waldport, OR 97394-9634
Mailing address
PO Box 2847
Corvallis, OR 97339-2847
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jwrazen6279@samhealth.direct-ci.com |
Other providers in Waldport, OR
- Timothy Alan Trautman
- Catherine Michelle Vallejo
- Lee A. Vogelman
- Waldport Eye Care LLC
- Joan Grier Wikler
All providers in Waldport, OR · Pediatrics Physician in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 3, 2020. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.