Active NPI
Larry Dean Jensen, DPM
- Foot Surgery Podiatrist
- Tigard, OR
National Provider Identifier
1851383269
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foot Surgery Podiatrist
- License
- DP00199
- Practice address
- 11815 SW King James Place
Suite 60
Tigard, OR 97224 - Phone
- (503) 639-8107
- Fax
- (503) 639-8108
- NPI assigned
- Aug 22, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot Surgery Podiatrist | 213ES0131X | DP00199 | OR | Primary |
Addresses
Primary practice location
11815 SW King James Place
Suite 60
Tigard, OR 97224
Mailing address
11815 SW King James Place
Suite 60
Tigard, OR 97224
Phone (503) 639-8107
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000265 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DP00199 | OR | MD | Foot Surgery Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1336089600000",
"number": "1851383269",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11815 SW KING JAMES PLACE",
"address_2": "SUITE 60",
"city": "TIGARD",
"state": "OR",
"postal_code": "97224",
"telephone_number": "503-639-8107",
"fax_number": "503-639-8108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11815 SW KING JAMES PLACE",
"address_2": "SUITE 60",
"city": "TIGARD",
"state": "OR",
"postal_code": "97224",
"telephone_number": "503-639-8107",
"fax_number": "503-639-8108"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENSEN",
"first_name": "LARRY",
"middle_name": "DEAN",
"credential": "DPM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-22",
"last_updated": "2012-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "213ES0131X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot Surgery",
"state": "OR",
"license": "DP00199",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000265",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tigard, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.