Individual provider Active NPI

Jennifer Wynn, ARNP

  • Family Nurse Practitioner
  • Vancouver, WA
National Provider Identifier
1750546537
Registry record updated Aug 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP60107358 Issued in WA
Practice address
200 NE Mother Joseph PL Ste 300
Vancouver, WA 98664
Phone
(360) 254-6161
Fax
(360) 449-1146
NPI assigned
Jul 22, 2008
Last updated
Aug 7, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2018

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 00157320 WA
Registered Nurse 163W00000X 200240758RN OR
Family Nurse Practitioner 363LF0000X 200950128NP OR
Family Nurse Practitioner 363LF0000X AP60107358 WA Primary

Addresses

Primary practice location

200 NE Mother Joseph PL Ste 300
Vancouver, WA 98664

Mailing address

200 NE Mother Joseph PL Ste 210
Vancouver, WA 98664-3295
Phone (360) 254-6161

Other identifiers 2

IdentifierTypeStateIssuer
0255099OtherWALABOR & INDUSTRIES
9662735MedicaidWA

Other names 1

  • Jennifer Plansky Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, OR2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20091028000813 WA Practitioner - Nurse Practitioner 6507903267 Reassigns benefits to 1 organization
I20140908001973 OR Practitioner - Nurse Practitioner 6507903267 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northwest Surgical Specialists PCGroup PAC ID 4183527153, 118 clinicians

Practice addresses (Care Compare)

1 N Ctr Court St
110 Rebound Sports Medicine
Portland, OR 97227-2104
Phone (503) 732-6863

200 NE Mother Joseph PL
Vancouver, WA 98664-3296
Phone (360) 254-6161

200 NE Mother Joseph PL
110 Rebound Orthopedics
Vancouver, WA 98664-3293
Phone (360) 254-6161

2121 NE 139TH St
300 Rebound
Vancouver, WA 98686-2316
Phone (360) 254-6161

2211 NE 139TH St
Legacy Salmon Creek Medical Center
Vancouver, WA 98686-2742
Phone (360) 487-1000

400 NE Mother Joseph PL
Peacehealth Southwest Medical Center
Vancouver, WA 98664-3200
Phone (360) 514-2000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
00157320WAMDRegistered Nurse
200950128NPORMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Surgical Specialists, P.C. CurrentSince Nov 14, 2010 Accepting new patients
Northwest Surgical Specialists PC CurrentSince Nov 14, 2010 Accepting new patients
J and D Physical Therapy Services Past Accepting new patients

Locations

1 N Center Court St
Ste 11
Portland, OR 97227
Phone (503) 732-6863

1 N Center Court St
Ste 110
Portland, OR 97227
Phone (503) 732-6863

200 NE Mother Joseph Pl
Vancouver, WA 98664
Phone (360) 514-2990

200 NE Mother Joseph Pl
Ste 210
Vancouver, WA 98664
Phone (360) 449-1145

200 NE Mother Joseph Pl
Ste 300
Vancouver, WA 98664
Phone (360) 256-4060

2121 NE 139th St
Ste 300
Vancouver, WA 98686

Interoperability endpoints

  • Direct secure messaging: jennifer.wynnarnp.p1@direct.reboundmd.nextgenshare.com
  • Direct secure messaging: jwynn21851@reboundmd.gardenplot.direct-ci.com

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 4

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": "1216684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533600000000",
    "number": "1750546537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 NE MOTHER JOSEPH PL STE 210",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986643295",
            "telephone_number": "360-254-6161",
            "fax_number": "360-449-1146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 NE MOTHER JOSEPH PL STE 300",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "98664",
            "telephone_number": "360-254-6161",
            "fax_number": "360-449-1146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNN",
        "first_name": "JENNIFER",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-22",
        "last_updated": "2018-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "00157320",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OR",
            "license": "200240758RN",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "200950128NP",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP60107358",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "0255099",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9662735",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "PLANSKY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.