Individual provider Active NPI

Jessica L Eggleston, AU.D.

  • Audiologist
  • Portland, OR
National Provider Identifier
1902107675
Registry record updated Nov 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
23356 Issued in OR
Practice address
9155 SW Barnes Rd Ste 536
Portland, OR 97225-6785
Phone
(503) 935-8100
NPI assigned
Nov 10, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 23356 OR Primary

Addresses

Primary practice location

9155 SW Barnes Rd Ste 536
Portland, OR 97225-6785

Mailing address

847 NE 19TH Ave Ste 300
Portland, OR 97232-2686
Phone (503) 963-2801

Other identifiers 1

IdentifierTypeStateIssuer
500632554MedicaidOR

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

LicenseStateTypeSpecialty
23356ORMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Eugene Hearing & Speech Center Audiologist Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1289347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604534400000",
    "number": "1902107675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "847 NE 19TH AVE STE 300",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322686",
            "telephone_number": "503-963-2801",
            "fax_number": "503-963-2825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9155 SW BARNES RD STE 536",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256785",
            "telephone_number": "503-935-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EGGLESTON",
        "first_name": "JESSICA",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "AU.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-10",
        "last_updated": "2020-11-05",
        "certification_date": "2020-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "OR",
            "license": "23356",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500632554",
            "state": "OR"
        }
    ],
    "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 Nov 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.