NPIMap

Individual provider Active NPI

Jay Christopher Andersen, M.D.

  • Hematology & Oncology Physician
  • Portland, OR
National Provider Identifier
1922001023
Registry record updated Dec 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
MD25119 Issued in OR
Practice address
9555 SW Barnes Rd
Ste 150
Portland, OR 97225-6663
Phone
(503) 297-7403
Fax
(503) 384-9908
NPI assigned
May 23, 2005
Last updated
Dec 22, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X MD25119 OR Primary

Addresses

Primary practice location

9555 SW Barnes Rd
Ste 150
Portland, OR 97225-6663

Mailing address

9555 SW Barnes Rd
Ste 150
Portland, OR 97225-6663
Phone (503) 297-7403

Other identifiers 2

IdentifierTypeStateIssuer
1022183MedicaidWA
022597MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, 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
I20040811001177 WA Practitioner - Hematology/Oncology 1153393962 Reassigns benefits to 1 organization
I20040812000186 OR Practitioner - Hematology/Oncology 1153393962 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
University of Kansas School of Med (KC/Wich/Sal), 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northwest Cancer Specialists PCGroup PAC ID 8426943838, 70 clinicians

Practice addresses (Care Compare)

12123 SW 69TH Ave
Tigard, OR 97223-8514
Phone (971) 708-7600

210 SE 136TH Ave
Vancouver, WA 98684-6930
Phone (360) 944-9889

265 N Broadway
Portland, OR 97227-1800
Phone (503) 280-1223

Hospital & facility affiliations

National Provider Directory

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

Interoperability endpoints

  • Direct secure messaging: jay.andersen@compass.ikm.direct-ci.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1116806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324512000000",
    "number": "1922001023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9555 SW BARNES RD",
            "address_2": "STE 150",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256663",
            "telephone_number": "503-297-7403",
            "fax_number": "503-384-9908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9555 SW BARNES RD",
            "address_2": "STE 150",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256663",
            "telephone_number": "503-297-7403",
            "fax_number": "503-384-9908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSEN",
        "first_name": "JAY",
        "middle_name": "CHRISTOPHER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-23",
        "last_updated": "2011-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "OR",
            "license": "MD25119",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1022183",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022597",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.