Individual provider Active NPI

Jacqueline Marie Hendrix, MD

  • Family Medicine Physician
  • Snohomish, WA
National Provider Identifier
1851915755
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD61318996 Issued in WA
Practice address
17432 State Route 9 SE
Snohomish, WA 98296-8451
Phone
(425) 404-7800
NPI assigned
Jun 5, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ML61067671 WA
Student in an Organized Health Care Education/Training Program 390200000X ML61067671 WA
Family Medicine Physician 207Q00000X MD61318996 WA Primary

Addresses

Primary practice location

17432 State Route 9 SE
Snohomish, WA 98296-8451

Mailing address

PO Box 3360
Portland, OR 97208-3360
Phone (866) 747-2455

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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

Enrollment IDStateProvider typePAC IDDetails
I20231008000194 WA Practitioner - Family Practice 4486077963 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Rush Medical College of Rush University, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

17432 State Route 9 SE
Suite 201
Snohomish, WA 98296-8451
Phone (425) 404-7800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD61318996WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services- Washington CurrentSince Oct 23, 2023 Accepting new patients
Providence Health & Services-Washington CurrentSince Oct 23, 2023 Accepting new patients
Providence Health & Services - Washington Family Medicine Past Accepting new patients
Radia Inc P S PastSince Oct 1, 2023 Accepting new patients

Locations

4112 Harbour Pointe Blvd SW
Ste 100
Mukilteo, WA 98275
Phone (425) 347-6330

17432 State Route 9 SE
Ste 201
Snohomish, WA 98296
Phone (360) 668-1820

Interoperability endpoints

  • Direct secure messaging: jhendrix3021552@wm.providencedirect.org

Organizations & group practices 4

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 2

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": "1591315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695859200000",
    "number": "1851915755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3360",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083360",
            "telephone_number": "866-747-2455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17432 STATE ROUTE 9 SE",
            "city": "SNOHOMISH",
            "state": "WA",
            "postal_code": "982968451",
            "telephone_number": "425-404-7800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRIX",
        "first_name": "JACQUELINE",
        "middle_name": "MARIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-05",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "ML61067671",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "WA",
            "license": "ML61067671",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD61318996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Snohomish, WA

Sources for this page

Verify at the official NPI Registry.