Jenell R Decker, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD60294725 Issued in WA

Practice address

1125 SE Washington
Pullman, WA 99164-0001

Phone

(509) 335-6127

Fax

(509) 335-6223

NPI assigned

Mar 8, 2006

Last updated

Sep 28, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Assure Health Medical Group PA

  • Internal Medicine Physician
  • Lauderdale Lakes, FL
  • NPI 1285252353
  Medicare reassignment NPD

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1851368864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 N GRAND AVE",
            "address_2": "SUITE 1",
            "city": "PULLMAN",
            "state": "WA",
            "postal_code": "99163",
            "telephone_number": "509-808-1933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 SE WASHINGTON",
            "city": "PULLMAN",
            "state": "WA",
            "postal_code": "991640001",
            "telephone_number": "509-335-6127",
            "fax_number": "509-335-6223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECKER",
        "first_name": "JENELL",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-08",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60294725",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64001423",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shane Randal Davis
• Dawnmd LLC (DawnMD)
• Dean Funabiki and Associates , P.S.
• Logan Dean
• Alisha Dearmin
• Robert Allen Delrosario, RPH
• Sara Michelle Desrosier
• Fikir Dessalegn
• James P Devleming, OD
• Devlin & Huberty PS (Moscow Pullman OB GYN)

• Family Medicine Physician in Pullman, WA
• Providers in Pullman, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; 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.