Active NPI
Jeffrey Owen Pentecost, D.O.
- General Practice Physician
- Portland, OR
National Provider Identifier
1861770190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- DO16894
- Practice address
- 3574 SE Harold CT
Portland, OR 97202-4344 - Phone
- (503) 280-1621
- NPI assigned
- Aug 3, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | DO16894 | OR | Primary |
Addresses
Primary practice location
3574 SE Harold CT
Portland, OR 97202-4344
Mailing address
3574 SE Harold CT
Portland, OR 97202-4344
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140306000422 | OR | Practitioner - Geriatric Medicine | 2466682737 | Practice locations: Gresham, OR; Portland, OR |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DO16894 | OR | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312329600000",
"number": "1861770190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3574 SE HAROLD CT",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972024344"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3574 SE HAROLD CT",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972024344",
"telephone_number": "503-280-1621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENTECOST",
"first_name": "JEFFREY",
"middle_name": "OWEN",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-08-03",
"last_updated": "2011-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "OR",
"license": "DO16894",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2011; 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.