Individual provider Active NPI

Jacey N Walrod, PA-C

  • Physician Assistant
  • Portland, OR
National Provider Identifier
1437820024
Registry record updated Oct 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA207078 Issued in OR
Practice address
10000 SE Main St Ste 224
Portland, OR 97216-2469
Phone
(503) 261-6961
NPI assigned
Sep 23, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA207078 OR Primary

Addresses

Primary practice location

10000 SE Main St Ste 224
Portland, OR 97216-2469

Mailing address

10000 SE Main St Ste 224
Portland, OR 97216-2469
Phone (503) 261-6961

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211111001428 OR Practitioner - Physician Assistant 7517356645 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Portland Adventist Medical CenterGroup PAC ID 3274908819, 273 clinicians
University Professional ServicesGroup PAC ID 4880760107, 1,683 clinicians

Practice addresses (Care Compare)

10123 SE Market St
Portland, OR 97216-2532
Phone (503) 257-2500

1400 SW 5TH Ave
Suite 500
Portland, OR 97201-5537

15700 SW Greystone CT
Beaverton, OR 97006-6011
Phone (503) 494-3442

Hospital & facility affiliations

  • Ohsu Hospital and Clinics Hospital, Portland, OR, CCN 380009
  • Adventist Health Portland Hospital, Portland, OR, CCN 380060

Merit-based Incentive Payment System (MIPS)

Final score
99.11 of 100Reported as apm
Quality
84.29
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA207078ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University Professional Services CurrentSince Oct 3, 2022 Accepting new patients
University Professional Services CurrentSince Oct 3, 2022 Accepting new patients
Portland Adventist Medical Center CurrentSince Dec 2, 2021 Accepting new patients

Locations

15700 SW Greystone Ct
Beaverton, OR 97006
Phone (503) 203-1000

14450 SE Royer Rd
Damascus, OR 97089
Phone (503) 658-5521

3181 SW Sam Jackson Park Rd
Portland, OR 97239
Phone (503) 494-5674

10000 SE Main St
Ste 224
Portland, OR 97216
Phone (503) 261-6961

10123 SE Market St
Portland, OR 97216
Phone (503) 251-6355

Interoperability endpoints

  • Direct secure messaging: jwalrod152516@direct.ohsu.edu

Organizations & group practices 5

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 2

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": "1632355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635206400000",
    "number": "1437820024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10000 SE MAIN ST STE 224",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972162469",
            "telephone_number": "503-261-6961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10000 SE MAIN ST STE 224",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972162469",
            "telephone_number": "503-261-6961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALROD",
        "first_name": "JACEY",
        "middle_name": "N",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-23",
        "last_updated": "2021-10-26",
        "certification_date": "2021-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA207078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.