Individual provider Active NPI

Brett Terry Jensen, MD

  • Emergency Medicine Physician
  • Vancouver, WA
National Provider Identifier
1649480088
Registry record updated Jan 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD00048963 Issued in WA
Practice address
600 NE 92ND Ave
Vancouver, WA 98664-3225
Phone
(360) 514-2142
Fax
(360) 514-6820
NPI assigned
May 23, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 28, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X LL16358 OR
Emergency Medicine Physician 207P00000X MD00048963 WA Primary

Addresses

Primary practice location

600 NE 92ND Ave
Vancouver, WA 98664-3225

Mailing address

PO Box 5037
Unit 282
Portland, OR 97208-5037
Phone (360) 514-2142

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
I20080403000394 WA Practitioner - Emergency Medicine 3678665742 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LL16358ORMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medicine Associates PC Emergency Medicine CurrentSince Jan 3, 2008 Accepting new patients
Peacehealth CurrentSince Jan 3, 2008 Accepting new patients

Locations

400 NE Mother Joseph Pl
Vancouver, WA 98664
Phone (360) 514-2000

600 NE 92nd Ave
Vancouver, WA 98664
Phone (360) 514-2142

Interoperability endpoints

  • Direct secure messaging: bjensen56238@direct.peacehealth.org

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201478400000",
    "number": "1649480088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5037",
            "address_2": "UNIT 282",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972085037",
            "telephone_number": "360-514-2142",
            "fax_number": "360-514-6820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 NE 92ND AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986643225",
            "telephone_number": "360-514-2142",
            "fax_number": "360-514-6820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENSEN",
        "first_name": "BRETT",
        "middle_name": "TERRY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-23",
        "last_updated": "2008-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OR",
            "license": "LL16358",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": "MD00048963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.