NPIMap

Individual provider Active NPI

Jenessa M Well, PA-C

  • Physician Assistant
  • Sherwood, OR
National Provider Identifier
1912665605
Registry record updated Oct 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA221219 Issued in OR
Practice address
16770 SW Edy Rd Ste 102
Sherwood, OR 97140-9679
Phone
(503) 216-9600
NPI assigned
Nov 30, 2021
Last updated
Oct 1, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 8812 AZ
Physician Assistant 363A00000X PA221219 OR Primary

Addresses

Primary practice location

16770 SW Edy Rd Ste 102
Sherwood, OR 97140-9679

Mailing address

PO Box 3158
Portland, OR 97208-3158
Phone (503) 215-6494

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, OR2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220117000348 AZ Practitioner - Physician Assistant 2567854995 Reassigns benefits to 1 organization
I20240822003441 OR Practitioner - Physician Assistant 2567854995 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1321 NE 99TH Ave
Suite 200
Portland, OR 97220-9439
Phone (503) 215-4250

16770 SW Edy Rd
Suite 102
Sherwood, OR 97140-9679
Phone (503) 216-9600

5050 NE Hoyt St
Suite 240
Portland, OR 97213-2981
Phone (503) 215-6480

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
8812AZMDPhysician Assistant
PA221219ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Oregon CurrentSince Sep 9, 2024 Accepting new patients
Khakwani and Mohammad Medical PC CurrentSince Apr 1, 2023 Accepting new patients
Providence Health & Services Oregon CurrentSince Sep 9, 2024 Accepting new patients
Providence Health & Services - Oregon Past Accepting new patients
Khakwani and Mohammad Medical PC Past Accepting new patients
Privia Medical Group Arizona, LLC Past Accepting new patients

Locations

1500 S Watson Rd
Ste C104
Buckeye, AZ 85326
Phone (623) 251-7559

4445 S Miller Rd
Ste 105B
Buckeye, AZ 85326
Phone (480) 319-9596

5270 W Baseline Rd
Ste 145
Laveen, AZ 85339
Phone (602) 675-2843

20542 N Lake Pleasant Rd
Ste 115
Peoria, AZ 85382
Phone (623) 476-5820

3540 E Baseline Rd
Ste 130
Phoenix, AZ 85042
Phone (480) 899-0767

2460 Paseo Verde Pkwy
Ste 145
Henderson, NV 89074

1321 NE 99th Ave
Ste 200
Portland, OR 97220
Phone (503) 215-4250

5050 NE Hoyt St
Ste 240
Portland, OR 97213
Phone (503) 215-6480

16770 SW Edy Rd
Ste 102
Sherwood, OR 97140
Phone (503) 215-9600

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1638230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727740800000",
    "number": "1912665605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "503-215-6494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16770 SW EDY RD STE 102",
            "city": "SHERWOOD",
            "state": "OR",
            "postal_code": "971409679",
            "telephone_number": "503-216-9600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELL",
        "first_name": "JENESSA",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-30",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "8812",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA221219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sherwood, OR

Sources for this page

Verify at the official NPI Registry.