Individual provider Active NPI

Jill Speaker, M.D.

  • Internal Medicine Physician
  • Vancouver, WA
National Provider Identifier
1609913243
Registry record updated Nov 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD00041013 Issued in WA
Practice address
900 NE 139TH St
Suite 202
Vancouver, WA 98685-2513
Phone
(360) 566-9355
Fax
(360) 816-1327
NPI assigned
Jan 31, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD00041013 WA Primary
Pediatrics Physician 208000000X MD00041013 WA

Addresses

Primary practice location

900 NE 139TH St
Suite 202
Vancouver, WA 98685-2513

Mailing address

900 NE 139TH St
Suite 202
Vancouver, WA 98685-2513
Phone (360) 566-9355

Other identifiers 1

IdentifierTypeStateIssuer
7125131MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041001000862 WA Practitioner - Pediatric MedicinePractitioner - Internal Medicine 1850360157 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Internal Medicine
Education
Baylor College of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Creekside Medical PSGroup PAC ID 4082683388, 3 clinicians

Practice addresses (Care Compare)

900 NE 139TH St
Suite 202
Vancouver, WA 98685-2513
Phone (360) 566-9355

Hospital & facility affiliations

  • Peacehealth Southwest Medical Cente Hospital, Vancouver, WA, CCN 500050
  • Legacy Salmon Creek Medical Center Hospital, Vancouver, WA, CCN 500150

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00041013WAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Creekside Medical, PS Internal Medicine CurrentSince Apr 12, 2004 Accepting new patients

Locations

900 NE 139th St
Ste 202
Vancouver, WA 98685
Phone (360) 566-9355

2501 NE 134th St
Ste 200
Vancouver, WA 98686
Phone (360) 200-5770

Organizations & group practices 1

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.

Hospital & facility affiliations 4

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": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446768000000",
    "number": "1609913243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 NE 139TH ST",
            "address_2": "SUITE 202",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986852513",
            "telephone_number": "360-566-9355",
            "fax_number": "360-816-1327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 NE 139TH ST",
            "address_2": "SUITE 202",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986852513",
            "telephone_number": "360-566-9355",
            "fax_number": "360-816-1327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPEAKER",
        "first_name": "JILL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-31",
        "last_updated": "2015-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD00041013",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00041013",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7125131",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.