NPIMap

Individual provider Active NPI

Jenna Marie Thiele, DO

  • Family Medicine Physician
  • Prineville, OR
National Provider Identifier
1710407275
Registry record updated Sep 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO198748 Issued in OR
Practice address
384 SE Combs Flat Rd Ste 1200
Prineville, OR 97754-2562
Phone
(541) 447-6263
Fax
(541) 447-8724
NPI assigned
Jun 26, 2017
Last updated
Sep 11, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 11019602A IN
Family Medicine Physician 207Q00000X 02005458A IN
Family Medicine Physician 207Q00000X DO198748 OR Primary

Addresses

Primary practice location

384 SE Combs Flat Rd Ste 1200
Prineville, OR 97754-2562

Mailing address

384 SE Combs Flat Rd Ste 1200
Prineville, OR 97754-2562
Phone (541) 447-6263

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jthiele106476@secure.stcharleshealthcare.org

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
I20200817002017 OR Practitioner - Family Practice 2668741422 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Charles Health System IncGroup PAC ID 3870402852, shared by 10 NPIs, 174 clinicians

Practice addresses (Care Compare)

384 SE Combs Flat Rd
Suite 1200
Prineville, OR 97754-2562
Phone (541) 706-2768

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St. Charles Health System, Inc. CurrentSince Aug 24, 2020 Accepting new patients
St. Charles Health System, Inc. CurrentSince Aug 24, 2020 Accepting new patients
St. Charles Health System, Inc. CurrentSince Jan 1, 2026 Accepting new patients
St. Charles Health System, Inc. Current Accepting new patients
St. Charles Health System, Inc. Past Accepting new patients

Locations

29358 Network Pl
Chicago, IL 60673

2500 NE Neff Rd
Bend, OR 97701
Phone (541) 388-4333

384 SE Combs Flat Rd
Prineville, OR 97754
Phone (541) 383-3668

384 SE Combs Flat Rd
Ste 1200
Prineville, OR 97754
Phone (541) 447-6263

1253 NW Canal Blvd
Redmond, OR 97756
Phone (541) 548-8131

Interoperability endpoints

  • Direct secure messaging: jthiele106476@secure.stcharleshealthcare.org

Organizations & group practices 5

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 6

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": "1498435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599782400000",
    "number": "1710407275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "384 SE COMBS FLAT RD STE 1200",
            "city": "PRINEVILLE",
            "state": "OR",
            "postal_code": "977542562",
            "telephone_number": "541-447-6263",
            "fax_number": "541-447-8724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "384 SE COMBS FLAT RD STE 1200",
            "city": "PRINEVILLE",
            "state": "OR",
            "postal_code": "977542562",
            "telephone_number": "541-447-6263",
            "fax_number": "541-447-8724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIELE",
        "first_name": "JENNA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-26",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "11019602A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02005458A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "DO198748",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jthiele106476@secure.stcharleshealthcare.org",
            "affiliation": "N",
            "address_1": "384 SE Combs Flat Rd Ste 1200",
            "city": "Prineville",
            "state": "OR",
            "country_code": "US",
            "postal_code": "977542562",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Prineville, OR

Sources for this page

Verify at the official NPI Registry.