Active NPI
Jennifer Penfield Nelson, P.A.
- Medical Physician Assistant
- Hillsboro, OR
National Provider Identifier
1518973015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 00813
- Practice address
- 2111 NE 25TH Ave Intel Health for Life Center
Ms:JF-167
Hillsboro, OR 97124 - Phone
- (503) 264-8315
- Fax
- (503) 264-0559
- NPI assigned
- Aug 1, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA00813 | OR | |
| Medical Physician Assistant | 363AM0700X | 00813 | OR | Primary |
Addresses
Primary practice location
2111 NE 25TH Ave Intel Health for Life Center
Ms:JF-167
Hillsboro, OR 97124
Mailing address
1945 NE Jamie Dr.
Hillsboro, OR 97124
Phone (503) 679-9460
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500617236 | Medicaid | OR |
Other names 1
- Jennifer Anne Penfield
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00813 | OR | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578009600000",
"number": "1518973015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1945 NE JAMIE DR.",
"city": "HILLSBORO",
"state": "OR",
"postal_code": "97124",
"telephone_number": "503-679-9460",
"fax_number": "971-327-4356"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2111 NE 25TH AVE INTEL HEALTH FOR LIFE CENTER",
"address_2": "MS:JF-167",
"city": "HILLSBORO",
"state": "OR",
"postal_code": "97124",
"telephone_number": "503-264-8315",
"fax_number": "503-264-0559"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "JENNIFER",
"middle_name": "PENFIELD",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-01",
"last_updated": "2020-01-03",
"certification_date": "2020-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OR",
"license": "PA00813",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "OR",
"license": "00813",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500617236",
"state": "OR"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JENNIFER",
"last_name": "PENFIELD",
"middle_name": "ANNE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Hillsboro, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2020; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.