Jennifer Bass, M.D.
Individual provider Active NPI Pediatrics Physician · Portland, OR
NPI 1730296351 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1730296351
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- MD 26070 (OR)
- Practice address
- 3550 N Interstate Ave
Portland, OR 97227-1196 - Phone
- (503) 331-6440
- Fax
- (503) 249-5286
- NPI assigned
- Aug 23, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OR, WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051007000283 | OR | Practitioner - Pediatric Medicine | 4880619956 | Reassigns benefits to 1 organization |
| I20090807000343 | WA | Practitioner - Pediatric Medicine | 4880619956 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD 26070 | OR | MD | Pediatrics Physician |
| MD00045407 | WA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kaiser Foundation Health Plan of the Northwest | Pediatrics | Current |
Accepting new patients |
| Kaiser Foundation Health Plan of the Northwest | Current |
Accepting new patients | |
| Kaiser Foundation Health Plan of the Northwest | Pediatrics | Current |
Accepting new patients |
Locations
10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946
3550 N Interstate Ave
Ofc
Portland, OR 97227
Phone (503) 285-9321
3550 N Interstate Ave
Portland, OR 97227
Phone (503) 285-9321
2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400
1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801
7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000
Interoperability endpoints
- jbassmd1065@direct.ohsu.edu
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD 26070 | OR | Yes |
| Pediatrics Physician | 208000000X | MD00045407 | WA |
Addresses
Primary practice location
3550 N Interstate Ave
Portland, OR 97227-1196
Mailing address
3550 N Interstate Ave
Portland, OR 97227-1196
Phone (503) 331-6440
Other providers in Portland, OR
- Sarah Hooper Basko
- Winn Baskow
- Crystal Ann Basler
- Brooke Bass
- Elisa Bass
- Miranda M Bass
- Olivia Jeanne Bass
- Tabitha Bass
- Jacob Keith Bassen
- Bridget Bassett
All providers in Portland, OR · Pediatrics Physician in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.