Active NPI
Gary A Jacobsen, MD
- Specialist
- Portland, OR
National Provider Identifier
1497998587
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MC08382
- Practice address
- 6327 SW Capitol Hwy. , Suite C
PMB 211
Portland, OR 97239 - Phone
- (503) 245-1274
- NPI assigned
- Apr 20, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MC08382 | OR | Primary |
Addresses
Primary practice location
6327 SW Capitol Hwy. , Suite C
PMB 211
Portland, OR 97239
Mailing address
6327 SW Capitol Hwy. , Suite C
PMB 211
Portland, OR 97239
Phone (503) 245-1274
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MC08382 | OR | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1240185600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1240185600000",
"number": "1497998587",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6327 SW CAPITOL HWY. , SUITE C",
"address_2": "PMB 211",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97239",
"telephone_number": "503-245-1274"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6327 SW CAPITOL HWY. , SUITE C",
"address_2": "PMB 211",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97239",
"telephone_number": "503-245-1274"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSEN",
"first_name": "GARY",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-04-20",
"last_updated": "2009-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "OR",
"license": "MC08382",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.