NPIMap

Individual provider Active NPI

Jeffrey P Pavelka, DO

  • Family Medicine Physician
  • Happy Valley, OR
National Provider Identifier
1447218318
Registry record updated Mar 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO-757 Issued in AL
Practice address
16180 SE Sunnyside Rd
Suite 102
Happy Valley, OR 97015-6302
Phone
(503) 582-4900
NPI assigned
May 2, 2006
Last updated
Mar 24, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DO28819 OR
Family Medicine Physician 207Q00000X DO-757 AL Primary

Addresses

Primary practice location

16180 SE Sunnyside Rd
Suite 102
Happy Valley, OR 97015-6302

Mailing address

PO Box 3158
Portland, OR 97208-3158

Other identifiers 2

IdentifierTypeStateIssuer
500601728MedicaidOR
051510830OtherALBCBS

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jpavelka134194@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081124000225 OR Practitioner - Family PracticePractitioner - General Practice 8628086378 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Chicago College of Osteopathy, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

5050 NE Hoyt St
Suite 240
Portland, OR 97213-2981
Phone (503) 215-6480

9290 SE Sunnybrook Blvd
Suite 120
Clackamas, OR 97015-6802
Phone (503) 215-2110

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
DO-757ALMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services - Oregon CurrentSince Dec 16, 2013 Accepting new patients
Providence Health & Services Oregon CurrentSince Dec 16, 2013 Accepting new patients
Coastal Care Corporation Past Accepting new patients
Providence Health & Services - Oregon Family Medicine Past Accepting new patients
Inphynet South Broward LLC Family Medicine Past Accepting new patients
Martin Memorial Medical Center Inc Past Accepting new patients
Martin Memorial Physician Corporation Inc Past Accepting new patients
Coastal Care Corporation Past Accepting new patients

Locations

9290 SE Sunnybrook Blvd
Ste 210
Clackamas, OR 97015
Phone (503) 216-7960

16180 SE Sunnyside Rd
Ste 102
Happy Valley, OR 97015
Phone (503) 582-4900

1321 NE 99th Ave
Ste 200
Portland, OR 97220
Phone (503) 215-4250

5050 NE Hoyt St
Ste 240
Portland, OR 97213
Phone (503) 215-6480

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616544000000",
    "number": "1447218318",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16180 SE SUNNYSIDE RD",
            "address_2": "SUITE 102",
            "city": "HAPPY VALLEY",
            "state": "OR",
            "postal_code": "970156302",
            "telephone_number": "503-582-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAVELKA",
        "first_name": "JEFFREY",
        "middle_name": "P",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-02",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "DO28819",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "DO-757",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500601728",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "051510830",
            "state": "AL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jpavelka134194@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "16180 SE SUNNYSIDE RD",
            "address_2": "SUITE 102",
            "city": "HAPPY VALLEY",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970156302",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Happy Valley, OR

Sources for this page

Verify at the official NPI Registry.