NPIMap

Individual provider Active NPI

Alycia Wai Lin Jackson, M.D.

  • Family Medicine Physician
  • Clackamas, OR
National Provider Identifier
1568807410
Registry record updated Feb 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD180196 Issued in OR
Practice address
9290 SE Sunnybrook Blvd
#120
Clackamas, OR 97015-6899
Phone
(503) 215-2110
Fax
(503) 215-2115
NPI assigned
May 6, 2013
Last updated
Feb 8, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD180196 OR Primary
Family Medicine Physician 207Q00000X A133720 CA

Addresses

Primary practice location

9290 SE Sunnybrook Blvd
#120
Clackamas, OR 97015-6899

Mailing address

9290 SE Sunnybrook Blvd
#120
Clackamas, OR 97015-6899
Phone (503) 215-2110

Other names 1

  • Miss Alycia Wai Lin Yee Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170704000000 OR Practitioner - Family Practice 1658685029 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Hawaii John a. Burns School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tuality Medical Group LLCGroup PAC ID 7416173414, 289 clinicians

Practice addresses (Care Compare)

335 SE 8TH Ave
Hillsboro, OR 97123-4246
Phone (503) 681-1111

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A133720CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Professional Services CurrentSince Sep 1, 2019 Accepting new patients
University Professional Services CurrentSince Sep 1, 2019 Accepting new patients
Tuality Medical Group LLC CurrentSince Dec 1, 2019 Accepting new patients
University Professional Services Current Accepting new patients
Oregon Health & Science University Current Accepting new patients
Oregon Health & Science University CurrentSince Nov 1, 2020 Accepting new patients
Oregon Health & Science University CurrentSince Nov 1, 2020 Accepting new patients
Tuality Medical Group LLC CurrentSince Dec 1, 2019 Accepting new patients

Locations

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

335 SE 8th Ave
Hillsboro, OR 97123
Phone (503) 681-1111

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

4411 SW Vermont St
Portland, OR 97219
Phone (503) 494-9992

Interoperability endpoints

  • Direct secure messaging: ajackson117443@direct.ohsu.edu

Organizations & group practices 8

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.

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1367798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486512000000",
    "number": "1568807410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9290 SE SUNNYBROOK BLVD",
            "address_2": "#120",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970156899",
            "telephone_number": "503-215-2110",
            "fax_number": "503-215-2115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9290 SE SUNNYBROOK BLVD",
            "address_2": "#120",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970156899",
            "telephone_number": "503-215-2110",
            "fax_number": "503-215-2115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ALYCIA",
        "middle_name": "WAI LIN",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-06",
        "last_updated": "2017-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD180196",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A133720",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALYCIA",
            "last_name": "YEE",
            "middle_name": "WAI LIN",
            "prefix": "MISS",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Clackamas, OR

Sources for this page

Verify at the official NPI Registry.