Kayla Jerde, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA191582 Issued in OR

Practice address

24076 SE Stark St Ste 230
Gresham, OR 97030-3385

Phone

(503) 488-2600

Fax

(503) 465-5468

NPI assigned

Dec 14, 2018

Last updated

Nov 11, 2024By the provider in NPPES

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

Enrolled in OR, CO2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Oregon Clinic, PCGroup PAC ID 2860390408, 353 clinicians

Boulder Medical Center, PCGroup PAC ID 4183536204, 86 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Legacy Mount Hood Medical Center Hospital, Gresham, OR, CCN 380025
• Providence Portland Medical Center Hospital, Portland, OR, CCN 380061

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kjerde1011223@oc.providencedirect.org

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.

• The Oregon Clinic PC

  • Specialist
  • Portland, OR
  • NPI 1265417174
  Medicare reassignment Care Compare group NPD
• Boulder Medical Center, P.C.

  • Multi-Specialty Clinic/Center
  • Boulder, CO
  • NPI 1306820923
  Medicare reassignment Care Compare group NPD
• Providence Health & Services - Oregon

  dba Providence Portland Medical Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1003991845
  Medicare reassignment
• Providence Health & Services - Oregon

  dba Providence Portland Medical Center

  • Clinical Pathology Physician
  • Portland, OR
  • NPI 1740732650
  NPD
• Providence Health & Services Oregon

  dba Providence Portland Medical Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Portland, OR
  • NPI 1396818993
  NPD
• The Oregon Clinic, PC

  • Durable Medical Equipment & Medical Supplies
  • Portland, OR
  • NPI 1346105129
  NPD
• Boulder Medical Center, P.C.

  • Urgent Care Clinic/Center
  • Boulder, CO
  • NPI 1114886587
  NPD
• Boulder Medical Center, P.C.

  • Multi-Specialty Clinic/Center
  • Boulder, CO
  • NPI 1174156939
  NPD
• Medical Center Pharmacy Inc

  dba Medical Center Pharmacy

  • Community/Retail Pharmacy
  • Salt Lake City, UT
  • NPI 1861495160
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Legacy Mount Hood Medical Center

  • General Acute Care Hospital
  • Gresham, OR
  • NPI 1255354700
  Care Compare affiliation
• Providence Health & Services - Oregon

  dba Providence Portland Medical Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1003991845
  Care Compare affiliation
• Providence Health & Services - Oregon

  • Case Manager/Care Coordinator
  • Portland, OR
  • NPI 1891822995

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1544745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731283200000",
    "number": "1497226716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 NE 20TH AVE STE 225",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322895",
            "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": "24076 SE STARK ST STE 230",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970303385",
            "telephone_number": "503-488-2600",
            "fax_number": "503-465-5468"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1111 NE 99th Ave Ste 101",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972209442",
            "country_code": "US",
            "telephone_number": "503-488-2626",
            "fax_number": "503-488-2630",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JERDE",
        "first_name": "KAYLA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-14",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA191582",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2115765",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500758641",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cc_otoc_ent_east_front_desk_pool12223123@or.providencedirect.org",
            "affiliation": "Y",
            "affiliationName": "The Oregon Clinic PC",
            "address_1": "24076 SE Stark St Ste 230",
            "city": "Gresham",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970303385",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ariel Jeffreys, LMT
• Ethan Jeffries, LMT
• Jonas Jenkins, MS, CCC-SLP
• Marteen Jensen, LPC
• Kathryn Elizabeth Jepsen, RN
• Emilee Nicole Jergensen, DC
• Courtney Monique Jessie, LPC
• Jill Turner ND PC
• Assefa Jima
• Jiyoung E Lee DMD PC (Gresham Pediatric Dentistry)

• Medical Physician Assistant in Gresham, OR
• Providers in Gresham, OR by specialty
• Medical Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.