NPIMap

Individual provider Active NPI

Jill Marie Shaw, D.O.

  • Gynecology Physician
  • Milwaukie, OR
National Provider Identifier
1770576340
Registry record updated May 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
DO25570 Issued in OR
Practice address
6564 SE Lake Rd Ste 200
Milwaukie, OR 97222-2237
Phone
(503) 908-5880
Fax
(888) 475-8729
NPI assigned
Aug 29, 2005
Last updated
May 18, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X DO25570 OR
Gynecology Physician 207VG0400X DO25570 OR Primary

Addresses

Primary practice location

6564 SE Lake Rd Ste 200
Milwaukie, OR 97222-2237

Mailing address

6564 SE Lake Rd Ste 200
Milwaukie, OR 97222-2237
Phone (503) 908-5880

Other identifiers 3

IdentifierTypeStateIssuer
1770576340MedicaidWA
213528MedicaidOR
218071OtherMEDICARE PIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060323000349 OR Practitioner - Obstetrics/Gynecology 4183632797 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Ohio University, College of Osteopathic Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jerrold L Snow LLCGroup PAC ID 2062597404, 3 clinicians

Practice addresses (Care Compare)

6564 SE Lake Rd
Suite 200
Milwaukie, OR 97222-2237
Phone (503) 908-5880

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Jerrold L Snow LLC CurrentSince Jun 1, 2020 Accepting new patients
Woodstock Family Medicine LLC Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

6564 SE Lake Rd
Ste 200
Portland, OR 97222
Phone (503) 477-4343

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/16993/brand/1/csg/1/fhir/r4
  • FHIR API: https://api.platform.athenahealth.com/18772/brand/1/csg/1/fhir/r4
  • Direct secure messaging: jill.shaw.1@18772.direct.athenahealth.com
  • Direct secure messaging: jshaw154802@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 2

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": "1125273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589760000000",
    "number": "1770576340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6564 SE LAKE RD STE 200",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972222237",
            "telephone_number": "503-908-5880",
            "fax_number": "888-475-8729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6564 SE LAKE RD STE 200",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972222237",
            "telephone_number": "503-908-5880",
            "fax_number": "888-475-8729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "JILL",
        "middle_name": "MARIE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-29",
        "last_updated": "2020-05-18",
        "certification_date": "2020-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OR",
            "license": "DO25570",
            "primary": false
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "OR",
            "license": "DO25570",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1770576340",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "213528",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "218071",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukie, OR

Sources for this page

Verify at the official NPI Registry.