Active NPI
Jill C Gladish, MD
- Psychiatry Physician
- Portland, OR
National Provider Identifier
1568607083
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MD29280
- Practice address
- 9155 SW Barnes Rd
Ste 333
Portland, OR 97225-6630 - Phone
- (503) 216-2028
- Fax
- (503) 216-2080
- NPI assigned
- Dec 12, 2008
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MD29280 | OR | Primary |
| Internal Medicine Physician | 207R00000X | MD29280 | OR |
Addresses
Primary practice location
9155 SW Barnes Rd
Ste 333
Portland, OR 97225-6630
Mailing address
PO Box 3158
Portland, OR 97208-3158
Phone (503) 215-6494
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500626198 | Medicaid | OR | |
| 500635943 | Medicaid | OR |
Other names 1
- Jill C Glazewski
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: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Previously, effective Sep 1, 2018 through Sep 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD29280 | OR | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1229040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377043200000",
"number": "1568607083",
"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",
"telephone_number": "503-215-6494",
"fax_number": "503-215-6644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9155 SW BARNES RD",
"address_2": "STE 333",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972256630",
"telephone_number": "503-216-2028",
"fax_number": "503-216-2080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLADISH",
"first_name": "JILL",
"middle_name": "C",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-12-12",
"last_updated": "2013-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "OR",
"license": "MD29280",
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "OR",
"license": "MD29280",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500626198",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500635943",
"state": "OR"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JILL",
"last_name": "GLAZEWSKI",
"middle_name": "C",
"credential": "MD",
"code": "1",
"type": "Former Name"
}
]
}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 Aug 21, 2013; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.