Individual provider Active NPI

Andrew Jennings, M.D.

  • Surgical Critical Care Physician
  • Vancouver, WA
National Provider Identifier
1982877478
Registry record updated Sep 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Critical Care PhysicianTaxonomy code 2086S0102X
License
MD60652293 Issued in WA
Practice address
505 NE 87TH Ave
Suite 301
Vancouver, WA 98664
Phone
(360) 514-1854
NPI assigned
Apr 7, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MD60652293 WA
Surgical Critical Care Physician 2086S0102X MD60652293 WA Primary

Addresses

Primary practice location

505 NE 87TH Ave
Suite 301
Vancouver, WA 98664

Mailing address

2710 Swiss Ave
Dallas, TX 75204-5900
Phone (214) 821-1599

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, WA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150303002217 TX Practitioner - General SurgeryPractitioner - Critical Care (Intensivists) 0648596916 Reassigns benefits to 2 organizations
I20160714000661 WA Practitioner - Critical Care (Intensivists)Practitioner - General Surgery 0648596916 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: General Surgery
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
PeacehealthGroup PAC ID 8820178288, 245 clinicians

Practice addresses (Care Compare)

505 NE 87TH Ave
Suite 301
Vancouver, WA 98664-1965
Phone (360) 514-2550

Hospital & facility affiliations

  • Peacehealth Southwest Medical Cente Hospital, Vancouver, WA, CCN 500050
  • Peacehealth St John Medical Center Hospital, Longview, WA, CCN 500041

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD60652293WAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Urgent Surgery Associates, P.a. CurrentSince Aug 5, 2014 Accepting new patients
Peacehealth Surgery CurrentSince Aug 22, 2016 Accepting new patients
North Texas Critical Care PA CurrentSince Aug 5, 2014 Accepting new patients
Peacehealth Past Accepting new patients

Locations

2710 Swiss Ave
Dallas, TX 75204
Phone (214) 821-2303

3701 Junius St
#11
Dallas, TX 75246

1400 8th Ave
Ft Worth, TX 76104
Phone (817) 922-1559

1115 SE 164th Ave
Dept 364
Vancouver, WA 98683
Phone (360) 735-8100

505 NE 87th Ave
Ste 301
Vancouver, WA 98664
Phone (360) 514-1854

Organizations & group practices 4

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.

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": "1207526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472774400000",
    "number": "1982877478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2710 SWISS AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752045900",
            "telephone_number": "214-821-1599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 NE 87TH AVE",
            "address_2": "SUITE 301",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "98664",
            "telephone_number": "360-514-1854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENNINGS",
        "first_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-07",
        "last_updated": "2016-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WA",
            "license": "MD60652293",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "WA",
            "license": "MD60652293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.