Individual provider Active NPI

Jon Stephan, MD

  • Anesthesiology Physician
  • Portland, OR
National Provider Identifier
1730196528
Registry record updated Feb 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD19821 Issued in OR
Practice address
10123 SE Market St
Portland, OR 97216-2532
Phone
(503) 257-2500
NPI assigned
Aug 2, 2006
Last updated
Feb 6, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD19821 OR Primary

Addresses

Primary practice location

10123 SE Market St
Portland, OR 97216-2532

Mailing address

1400 SW 5TH Ave
Portland, OR 97201-5537

Other identifiers 3

IdentifierTypeStateIssuer
8195232MedicaidWA
050044964OtherORRR MEDICARE
081070MedicaidOR

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20101029000689 OR Practitioner - Anesthesiology 7719171107 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Loma Linda University School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Portland Adventist Medical CenterGroup PAC ID 3274908819, 273 clinicians

Practice addresses (Care Compare)

10123 SE Market St
Portland, OR 97216-2532
Phone (503) 257-2500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92 of 100Reported as group
Quality
84.7
Promoting interoperability
100
Improvement activities
40
Cost
79.21

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD19821ORMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Portland Adventist Medical Center Anesthesiology CurrentSince Jan 31, 2024 Accepting new patients
Portland Adventist Medical Center CurrentSince Jan 31, 2024 Accepting new patients
Oag Trauma Services LLC Anesthesiology PastSince Apr 19, 1996 Accepting new patients

Locations

10151 SE Sunnyside Rd
Ste 100
Clackamas, OR 97015
Phone (503) 659-0880

10123 SE Market St
Portland, OR 97216
Phone (503) 251-6355

Interoperability endpoints

  • Direct secure messaging: jstephan154833@direct.ohsu.edu

Organizations & group practices 3

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 1

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": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707177600000",
    "number": "1730196528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 SW 5TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972015537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10123 SE MARKET ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972162532",
            "telephone_number": "503-257-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPHAN",
        "first_name": "JON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2024-02-06",
        "certification_date": "2024-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OR",
            "license": "MD19821",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8195232",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "050044964",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "081070",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.