David Ali Jimenez

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

10013999 Issued in OR

Practice address

12121 E Burnside St
Portland, OR 97216-3737

Phone

(971) 361-7700

NPI assigned

Sep 3, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: djimenez665357@direct.ochin.org

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692057600000",
    "number": "1770197071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "232 NW 6TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972093609",
            "telephone_number": "503-294-1681",
            "fax_number": "503-294-4321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12121 E BURNSIDE ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972163737",
            "telephone_number": "971-361-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIMENEZ",
        "first_name": "DAVID",
        "middle_name": "ALI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-03",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OR",
            "license": "201909027RN",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "10013999",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adolfo Jimenez, LCSW/CADC-R
• Alexiss Jimenez
• Anjulia Jimenez, PA-S
• Anna Jimenez, MD
• Clarisa Jimenez, RN
• Elizabeth Jimenez
• Jesse Angel Jimenez, CASAC
• Jessica Jimenez, FNP
• Lidia Magali Jimenez
• Marysol Jimenez, CADC I

• Psychiatric/Mental Health Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Psychiatric/Mental Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.