Individual provider Active NPI

Andrew Jensen, CRNA

  • Certified Registered Nurse Anesthetist
  • Longview, WA
National Provider Identifier
1831442235
Registry record updated Apr 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
AP60633494 Issued in WA
Practice address
1615 Delaware St
Longview, WA 98632-2367
Phone
(360) 414-2000
Fax
(360) 414-7638
NPI assigned
Oct 23, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 43-557134-111 KS
Certified Registered Nurse Anesthetist 367500000X AP60633494 WA Primary

Addresses

Primary practice location

1615 Delaware St
Longview, WA 98632-2367

Mailing address

1526 Legend Trail Dr Unit a
Lawrence, KS 66047-2555
Phone (503) 804-9498

Other practice location 1

1700 SW 7th St
Topeka, KS 66606-2489
Phone (785) 295-8000

Other practice location 2

2312 NE 129th St
Vancouver, WA 98686-3236
Phone (360) 514-7060

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE) Northwest Permanente PC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160519001991 WA Practitioner - Certified Registered Nurse Anesthetist (Crna) 4880830504 Reassigns benefits to 3 organizations
I20200120000516 OR Practitioner - Certified Registered Nurse Anesthetist (Crna) 4880830504 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
PeacehealthGroup PAC ID 5890689293, 188 clinicians

Practice addresses (Care Compare)

1615 Delaware St
Longview, WA 98632-2367
Phone (360) 636-4814

Hospital & facility affiliations

  • Peacehealth St John Medical Center Hospital, Longview, WA, CCN 500041

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
43-557134-111KSMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Jul 24, 2020 Accepting new patients
Columbia Anesthesia Group P S CurrentSince May 3, 2016 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Nurse Anesthetist, Certified Registered CurrentSince Jul 24, 2020 Accepting new patients
Peacehealth CurrentSince Jun 17, 2023 Accepting new patients
Peacehealth CurrentSince Jan 3, 2023 Accepting new patients

Locations

10180 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2880

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

1015 NW 22nd Ave
Portland, OR 97210
Phone (503) 413-7582

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

7300 SW Childs Rd
Ste A
Tigard, OR 97224
Phone (360) 828-5396

1615 Delaware St
Longview, WA 98632
Phone (360) 363-4818

400 NE Mother Joseph Pl
Vancouver, WA 98664
Phone (360) 514-2000

2211 NE 139th St
Vancouver, WA 98686
Phone (360) 397-1985

2312 NE 129th St
Vancouver, WA 98686
Phone (360) 546-8950

Interoperability endpoints

  • Direct secure messaging: ajensen254174@direct.peacehealth.org

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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": "1350950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681776000000",
    "number": "1831442235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1526 LEGEND TRAIL DR UNIT A",
            "city": "LAWRENCE",
            "state": "KS",
            "postal_code": "660472555",
            "telephone_number": "503-804-9498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 DELAWARE ST",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322367",
            "telephone_number": "360-414-2000",
            "fax_number": "360-414-7638"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1700 SW 7th St",
            "address_purpose": "LOCATION",
            "city": "Topeka",
            "state": "KS",
            "postal_code": "666062489",
            "country_code": "US",
            "telephone_number": "785-295-8000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2312 NE 129th St",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986863236",
            "country_code": "US",
            "telephone_number": "360-514-7060",
            "fax_number": "360-729-3162",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JENSEN",
        "first_name": "ANDREW",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-23",
        "last_updated": "2023-04-18",
        "certification_date": "2023-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KS",
            "license": "43-557134-111",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WA",
            "license": "AP60633494",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Northwest Permanente PC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10180 SE Sunnyside Rd",
            "city": "Clackamas",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970158970",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Longview, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.