Jack A. Rosenberg, M. D.

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

MD08402 Issued in OR

Practice address

5920 N. E. Ray Circle
Suite 220
Hillsboro, OR 97124-6313

Phone

(503) 690-0707

Fax

(503) 690-9796

NPI assigned

Apr 11, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493337600000",
    "number": "1790748556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5920 N.E. RAY CIRCLE",
            "address_2": "SUITE 220",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971246313",
            "telephone_number": "503-690-0707",
            "fax_number": "503-690-9796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5920 N. E. RAY CIRCLE",
            "address_2": "SUITE 220",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971246313",
            "telephone_number": "503-690-0707",
            "fax_number": "503-690-9796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSENBERG",
        "first_name": "JACK",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "M. D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-11",
        "last_updated": "2017-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD08402",
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "OR",
            "license": "MD08402",
            "primary": true
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "OR",
            "license": "MD08402",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164012",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Abigail Morgan Rose
• Elyssa Anne Rose, ATS
• Erik Ernest Rosekrans, ARNP
• Sarina Rosen, LPC
• Rachel Rosenbaum
• Charles R Rosenblatt, MD
• Gregory Scott Rosenblatt, M.D.
• Rosewood Master Tenant LLC
• Mikaela Roska
• Alyssa Ross

• Pediatric Adolescent Medicine Physician in Hillsboro, OR
• Providers in Hillsboro, OR by specialty
• Pediatric Adolescent Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.