Individual provider Active NPI

Jeffrey Edward Ford, M.D.

  • Family Medicine Physician
  • Vancouver, WA
National Provider Identifier
1750478558
Registry record updated Jul 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD00032604 Issued in WA
Practice address
14406 NE 20TH Ave
Vancouver, WA 98686-1448
Phone
(360) 418-6001
Fax
(360) 571-3108
NPI assigned
Oct 5, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 17, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD00032604 WA Primary
Family Medicine Physician 207Q00000X MD18943 OR

Addresses

Primary practice location

14406 NE 20TH Ave
Vancouver, WA 98686-1448

Mailing address

14406 NE 20TH Ave
Vancouver, WA 98686-1448
Phone (360) 481-6001

Other identifiers 1

IdentifierTypeStateIssuer
8161945MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20050606000448 OR Practitioner - Family Practice 3577506112 Reassigns benefits to 1 organization
I20070827000174 WA Practitioner - Family Practice 3577506112 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Saint Louis University School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kaiser Foundation Health Plan of the NorthwestGroup PAC ID 5799688230, 1,805 clinicians

Practice addresses (Care Compare)

10100 SE Sunnyside Rd
Clackamas, OR 97015-8970
Phone (800) 813-2000

10180 SE Sunnyside Rd
Clackamas, OR 97015-8970
Phone (800) 813-2000

19500 SE Stark St
Portland, OR 97233-5757
Phone (800) 813-2000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD18943ORMDFamily Medicine Physician
MD00032604WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Nov 17, 2009 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Family Medicine Current Accepting new patients
Kaiser Foundation Health Plan of the Northwest Family Medicine CurrentSince Jul 1, 2015 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Nov 17, 2009 Accepting new patients

Locations

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801

2211 E Mill Plain Blvd
Vancouver, WA 98661
Phone (360) 418-6001

14406 NE 20th Ave
Vancouver, WA 98686
Phone (360) 418-6001

14406 NE 20th Ave
Ofc
Vancouver, WA 98686
Phone (360) 418-6001

7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000

Organizations & group practices 4

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": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184630400000",
    "number": "1750478558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14406 NE 20TH AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986861448",
            "telephone_number": "360-481-6001",
            "fax_number": "360-571-3108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14406 NE 20TH AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986861448",
            "telephone_number": "360-418-6001",
            "fax_number": "360-571-3108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORD",
        "first_name": "JEFFREY",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2007-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00032604",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD18943",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8161945",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.