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AJITKUMAR N JETMALANI MD
NPI 1104994920
Psychiatry & Neurology - Child & Adolescent Psychiatry in Portland, OR

Active since December 01, 2006PECOS Enrolled
97.83/100
CMS Quality Rating
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239(503) 494-6176(503) 494-6152 Get Directions Write a Review

NPPES record last updated: December 11, 2018. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Ajitkumar N Jetmalani Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AJITKUMAR N JETMALANI MD (NPI 1104994920) is an individual child & adolescent psychiatry provider in Portland, Oregon, licensed in Oregon (MD15652) and active in the NPI registry since December 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1104994920
Entity TypeIndividualMale
Primary Taxonomy2084P0804X
Provider Legal NameAJITKUMAR N JETMALANICredential: MD
Location Address3181 SW SAM JACKSON PARK RDPortland, OR 97239-3011
Mailing Address3181 Sw Sam Jackson Park RdPortland, OR 97239-3011 · (503) 494-6176 · Fax (503) 494-6152
Phone(503) 494-6176
Fax(503) 494-6152
Sole ProprietorNo
Enumeration DateDecember 1, 2006
Last NPPES UpdateDecember 11, 2018
✔ NPI 1104994920 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPsychiatry & Neurology · Child & Adolescent PsychiatryAllopathic & Osteopathic Physicians
Taxonomy Code2084P0804X
License✔ Licensed in OR · MD15652
Definition
Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence.
Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X · License MD15652 (OR)
3181 SW SAM JACKSON PARK RD, Portland, OR 97239
Open in Google Maps ↗

Other Identifiers 1

MedicaidZ10716OR

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Regence BlueCross BlueShield of Oregon.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ajitkumar N Jetmalani Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Ajitkumar Jetmalani reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

University Professional Services
Same address
Multi-Specialty
707 SW GAINES ST
Portland, OR 97239
  • Reassigned Medicare billing, Oregon enrollment
  • 2,212 clinicians in this Medicare group
NPI 1073767588 (503) 494-9000
Legacy Emanuel Hospital & Health Center
2.4 mi
General Acute Care Hospital
1225 NE 2ND AVE
Portland, OR 97232
  • Reassigned Medicare billing, Oregon enrollment
  • 719 clinicians in this Medicare group
NPI 1003367491 (503) 944-8000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

97.83/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality80.97
Promoting Interoperability100
Improvement Activities40

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DONALD RICHARD SULLIVAN MD
Internal Medicine (Pulmonary Disease)
3181 SW SAM JACKSON PARK RD, UHN67
PORTLAND, OR 97239
Multnomah County (503) 494-6949
MRS. ANJALEE NIX ROWE NP
Nurse Practitioner (Acute Care)
3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239
Multnomah County (503) 494-3988
REEM HASAN MD
Internal Medicine
3181 SW SAM JACKSON PARK RD, PPV 350
PORTLAND, OR 97239
Multnomah County (503) 494-8562
DR. AMANDA D BALL PSY.D
Psychologist (Clinical)
3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239
Multnomah County (503) 494-6176
SUNSHINE WELSCH LMT
Massage Therapist
3181 SW SAM JACKSON PARK RD, 7D19
PORTLAND, OR 97239
Multnomah County (503) 494-8349
DR. ROBERT GENE MEALER M.D., PH.D.
Psychiatry & Neurology (Psychiatry)
3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239
Multnomah County (503) 494-6176
GREGORY HALL MD
Radiology (Diagnostic Radiology)
3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239
Multnomah County (503) 418-0990
DR. BURHAN AHMED MIAN MD
Student in an Organized Health Care Education/Training Program
3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239
Multnomah County (503) 494-8311

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ajitkumar Jetmalani's NPI number?

The NPI number for Ajitkumar Jetmalani is 1104994920. It was assigned to this individual provider in the NPPES registry on December 1, 2006.

Where is Ajitkumar Jetmalani located?

Ajitkumar Jetmalani practices at 3181 SW Sam Jackson Park Rd, Portland, OR 97239. The listed phone number is (503) 494-6176.

What is Ajitkumar Jetmalani's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Child & Adolescent Psychiatry, with taxonomy code 2084P0804X.

Is Ajitkumar Jetmalani enrolled in Medicare?

Yes. Ajitkumar Jetmalani is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Ajitkumar Jetmalani's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Ajitkumar Jetmalani reassigns Medicare benefits to 2 organizations: University Professional Services (Portland, OR) and Legacy Emanuel Hospital & Health Center (Portland, OR). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Ajitkumar Jetmalani's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Ajitkumar Jetmalani accept?

Health plans from BridgeSpan Health Company and Regence BlueCross BlueShield of Oregon list Ajitkumar Jetmalani as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Ajitkumar Jetmalani was last updated on December 11, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.