Jennifer Anne Lietzke, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD28993 Issued in OR

Practice address

2935 SW Cedar Hills Blvd
Beaverton, OR 97005-1342

Phone

(503) 352-6000

Fax

(503) 352-6080

NPI assigned

Jun 23, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

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

Specialty

Family Practice

Education

University of Chicago, Pritzker School of Medicine, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Virginia Garcia Memorial Health CenterGroup PAC ID 7113823881, 87 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: jlietzke13178@direct.ochin.org

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.

• Virginia Garcia Memorial Health Center

  • Federally Qualified Health Center (FQHC)
  • Cornelius, OR
  • NPI 1679528012
  Medicare reassignment Care Compare group
• Emergency Medicine of Indiana

  • Emergency Medicine Physician
  • Fort Wayne, IN
  • NPI 1952356883
  NPD (past)
• Valley-Wide Health Systems, Inc.

  • Federally Qualified Health Center (FQHC)
  • Alamosa, CO
  • NPI 1205652047
  NPD (past)

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517875200000",
    "number": "1699701631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6149",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970070149",
            "telephone_number": "503-352-8657",
            "fax_number": "503-352-8658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2935 SW CEDAR HILLS BLVD",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970051342",
            "telephone_number": "503-352-6000",
            "fax_number": "503-352-6080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIETZKE",
        "first_name": "JENNIFER",
        "middle_name": "ANNE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-23",
        "last_updated": "2018-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD28993",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500634215",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Yanda Li
• Liana Hategan MD PC
• Lice Charmers
• Rebecca Janette Lidel, RPH
• Meredith Stephanie Lieb-Alsop, M.A, MFT
• Life Alchemy Therapy LLC
• Lifequal, LLC
• Lifeworks NW
• Lifting Clouds Therapy
• Herbert H Lim, MD

• Family Medicine Physician in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.