Individual provider Active NPI

Jennifer Tobin, PA-C

  • Medical Physician Assistant
  • Portland, OR
National Provider Identifier
1508947755
Registry record updated Dec 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA165082 Issued in OR
Practice address
3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone
(503) 494-7641
NPI assigned
Oct 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA10004894 WA
Surgical Physician Assistant 363AS0400X PA165082 OR
Medical Physician Assistant 363AM0700X PA165082 OR Primary

Addresses

Primary practice location

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011

Mailing address

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone (503) 494-7641

Other practice location 1

875 Oak St SE
Suite 5020
Salem, OR 97301-3975
Phone (503) 371-4044

Other identifiers 1

IdentifierTypeStateIssuer
500664202MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, OR2 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

Enrollment IDStateProvider typePAC IDDetails
I20070215000323 WA Practitioner - Physician Assistant 2062414303 Reassigns benefits to 1 organization
I20131024001299 OR Practitioner - Physician Assistant 2062414303 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University Professional ServicesGroup PAC ID 4880760107, 1,683 clinicians
Oregon Health and Science UniversityGroup PAC ID 1759328842, 93 clinicians

Practice addresses (Care Compare)

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

3303 S Bond Ave
Portland, OR 97239-4501
Phone (503) 494-8311

3930 SE Division St
Portland, OR 97202-1643
Phone (503) 418-3900

4212 SE Division St
Portland, OR 97206-1681
Phone (503) 418-1500

51377 SW Old Portland Rd
Scappoose, OR 97056-4023
Phone (503) 418-4222

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
PA165082ORMDMedical Physician Assistant
PA10004894WAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Uptown Providers PC CurrentSince Dec 30, 2024 Accepting new patients
Uptown Providers PC CurrentSince Jul 1, 2023 Accepting new patients
Uptown Providers PC CurrentSince Jul 1, 2023 Accepting new patients
University Professional Services CurrentSince Jun 25, 2020 Accepting new patients
Oregon Health & Science University CurrentSince Jan 1, 2024 Accepting new patients
University Professional Services CurrentSince Jun 25, 2020 Accepting new patients
Salem Health CurrentSince Jul 22, 2015 Accepting new patients
Salem Health CurrentSince Jul 22, 2015 Accepting new patients
Moses Lake Community Health Center Past Accepting new patients

Locations

14278 SW Allen Blvd
Beaverton, OR 97005

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

3303 S Bond Ave
Portland, OR 97239
Phone (503) 494-3151

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

3930 SE Division St
Portland, OR 97202
Phone (503) 418-3900

665 Winter St SE
Salem, OR 97301
Phone (503) 370-5634

875 Oak St SE
Ste 5020
Salem, OR 97301
Phone (503) 371-4044

51377 SW Old Portland Rd
Scappoose, OR 97056
Phone (503) 418-4222

8060 SW Pfaffle St
Ste 106
Tigard, OR 97223

180 NE 192nd Ave
Ste 505
Vancouver, WA 98684

Interoperability endpoints

  • Direct secure messaging: jtobin92960@direct.ohsu.edu

Organizations & group practices 13

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.

View all 13

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": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608595200000",
    "number": "1508947755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393011",
            "telephone_number": "503-494-7641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393011",
            "telephone_number": "503-494-7641"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "875 Oak St SE",
            "address_2": "Suite 5020",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OR",
            "postal_code": "973013975",
            "country_code": "US",
            "telephone_number": "503-371-4044",
            "fax_number": "503-371-4356",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TOBIN",
        "first_name": "JENNIFER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-17",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10004894",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OR",
            "license": "PA165082",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA165082",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500664202",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.