Jacob R Hodge, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

MD218008 Issued in OR

Practice address

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011

Phone

(503) 418-0990

NPI assigned

Jun 18, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in WI, OR2 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

Specialty

Diagnostic Radiology

Education

University of Minnesota Medical School, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University Professional ServicesGroup PAC ID 4880760107, 1,683 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ohsu Hospital and Clinics Hospital, Portland, OR, CCN 380009
• Adventist Health Portland Hospital, Portland, OR, CCN 380060
• Providence St Vincent Medical Center Hospital, Portland, OR, CCN 380004
• Providence Newberg Medical Center Hospital, Newberg, OR, CCN 380037
• Adventist Health Tillamook Hospital, Tillamook, OR, CCN 381317

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• University Professional Services

  • General Practice Physician
  • Portland, OR
  • NPI 1376709535
  Medicare reassignment Care Compare group NPD
• Allina Health System

  • General Practice Physician
  • River Falls, WI
  • NPI 1407395247
  Medicare reassignment NPD
• Allina Health System

  • Emergency Medicine Physician
  • River Falls, WI
  • NPI 1578507513
  Medicare reassignment NPD
• Allina Health System

  • Family Medicine Physician
  • Annandale, MN
  • NPI 1457657249
  Medicare reassignment
• St. Croix Regional Medical Center

  • Critical Access Hospital
  • Saint Croix Falls, WI
  • NPI 1043240922
  Medicare reassignment
• Ohsu Outpatient Clinical Services LLC

  • Physiological Laboratory
  • Portland, OR
  • NPI 1194568469
  NPD
• University Professional Services

  • Pharmacy
  • Beaverton, OR
  • NPI 1073054714
  NPD
• University Professional Services

  • Multi-Specialty Clinic/Center
  • Portland, OR
  • NPI 1073767588
  NPD
• Allina Health System

  • Family Medicine Physician
  • St Paul, MN
  • NPI 1023314804
  NPD
• Allina Health System

  • Hematology & Oncology Physician
  • River Falls, WI
  • NPI 1568999712
  NPD
• P R Health Corporation

  • Critical Access Hospital
  • Park River, ND
  • NPI 1679669741
  NPD
• St Joseph'S Hospital and Health Center

  • Critical Access Hospital
  • Dickinson, ND
  • NPI 1992947956
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Northwest Medical Foundation of Tillamook

  • Land Ambulance
  • Tillamook, OR
  • NPI 1508849407

  Hospital

  Care Compare affiliation
• Northwest Medical Foundation of Tillamook

  • Critical Access Hospital
  • Tillamook, OR
  • NPI 1699146159
  Care Compare affiliation
• Northwest Medical Foundation of Tillamook

  • Rural Health Clinic/Center
  • Tillamook, OR
  • NPI 1841451853

  Hospital

  Care Compare affiliation
• Northwest Medical Foundation of Tillamook

  • Critical Access Hospital
  • Tillamook, OR
  • NPI 1871575225
  Care Compare affiliation
• Oregon Health & Science University

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1609824010
  Care Compare affiliation
• Portland Adventist Medical Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1801887658
  Care Compare affiliation
• Providence Health & Services - Oregon

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1114015971
  Care Compare affiliation
• Providence Health & Services - Oregon

  • General Acute Care Hospital
  • Newberg, OR
  • NPI 1952482275
  Care Compare affiliation

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

{
    "created_epoch": "1213747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705536000000",
    "number": "1811158256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393011",
            "telephone_number": "503-418-0990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393011",
            "telephone_number": "503-418-0990"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4801 W 81st St Ste 108",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "MN",
            "postal_code": "554371111",
            "country_code": "US",
            "telephone_number": "952-837-9700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "250 Thompson St",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551022370",
            "country_code": "US",
            "telephone_number": "651-292-2000",
            "fax_number": "651-292-2136",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9055 Springbrook Dr NW",
            "address_purpose": "LOCATION",
            "city": "Coon Rapids",
            "state": "MN",
            "postal_code": "554335841",
            "country_code": "US",
            "telephone_number": "763-780-9155",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HODGE",
        "first_name": "JACOB",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-18",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MN",
            "license": "104519",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MN",
            "license": "52240",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OR",
            "license": "MD218008",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01235327",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ellen Hodell, M.ED., BCBA
• Cassandra Evelyn Hodge, CNM
• Charles Bryan Hodge, MNM
• Cynthia Hodge
• Dayle Quennel Hodge, MD, MS, PHD
• Janet S Hodge, RDN LD CDCES
• Rebecca Hodge
• Tierney Hodge, MED, MA
• Aleecia Roshelle Hodges, BIRTH DOULA
• Jonathan Ryan Hodges

• Diagnostic Radiology Physician in Portland, OR
• Providers in Portland, OR by specialty
• Diagnostic Radiology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.