Individual provider Active NPI

Jerry J Yoon, DPM

  • Podiatrist
  • Lake Oswego, OR
National Provider Identifier
1871585802
Registry record updated Sep 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
DP00338 Issued in OR
Practice address
4800 Meadows Rd Ste 120
Lake Oswego, OR 97035-4264
Phone
(503) 636-9656
Fax
(503) 636-9657
NPI assigned
Aug 16, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 4, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X DP00338 OR Primary

Addresses

Primary practice location

4800 Meadows Rd Ste 120
Lake Oswego, OR 97035-4264

Mailing address

4800 Meadows Rd Ste 120
Lake Oswego, OR 97035-4264
Phone (503) 636-9656

Other identifiers 1

IdentifierTypeStateIssuer
286958MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050914001334 OR Practitioner - Podiatry 9739112293 Practice locations: Lake Oswego, OR
O20150817002063 OR DME Supplier - Physician - General PracticeDME Supplier - Other 2668683954 Practice locations: Lake Oswego, OR

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
California School of Podiatric Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4000 Kruse Way PL
Lake Oswego, OR 97035-5545
Phone (503) 636-9656

Merit-based Incentive Payment System (MIPS)

Final score
91.25 of 100Reported as individual
Quality
86.83
Promoting interoperability
95
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue73
Removal of skin lesions20
Removal of nail tissue1331
Removal or shaving of skin growth1263

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DP00338ORMDPodiatrist

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GDHGCA/Endpoint/GDHGCA

NPI Registry JSON

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788480000000",
    "number": "1871585802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 MEADOWS RD STE 120",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970354264",
            "telephone_number": "503-636-9656",
            "fax_number": "503-636-9657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 MEADOWS RD STE 120",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970354264",
            "telephone_number": "503-636-9656",
            "fax_number": "503-636-9657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOON",
        "first_name": "JERRY",
        "middle_name": "J",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-16",
        "last_updated": "2026-09-04",
        "certification_date": "2026-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "OR",
            "license": "DP00338",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "286958",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Oswego, OR

Sources for this page

Verify at the official NPI Registry.