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JACK RANDELL WELLS PSYD
NPI 1316246937
Psychologist - Clinical in Portland, OR

Active since March 22, 2011PECOS Enrolled
9135 SW BARNES RD STE 561, PORTLAND, OR 97225(503) 216-2339 Get Directions Write a Review

NPPES record last updated: May 13, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: May 13, 2025, Dec 30, 2019 (2 updates tracked since 2019).

About Jack Randell Wells Psyd NPPES

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

JACK RANDELL WELLS PSYD (NPI 1316246937) is an individual clinical provider in Portland, Oregon, licensed in Oregon (3238) and active in the NPI registry since March 2011. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1316246937
Entity TypeIndividualMale
Primary Taxonomy103TC0700X
Provider Legal NameJACK RANDELL WELLSCredential: PSYD
Location Address9135 SW BARNES RD STE 561Portland, OR 97225-6643
Mailing AddressPo Box 3158Portland, OR 97208-3158 · (503) 215-6494
Phone(503) 216-2339
Sole ProprietorNo
Enumeration DateMarch 22, 2011
Last NPPES UpdateMay 13, 20252 updates tracked since enumeration
NPPES CertifiedMay 13, 2025
✔ NPI 1316246937 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
Licenses✔ Licensed in OR · 3238✔ Licensed in CO · PSY.0005193
Definition
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
9135 SW BARNES RD STE 561, Portland, OR 97225
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jack Randell Wells Psyd 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 Reassignment

Medicare enrollment records show Jack Wells reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Providence Health & Services - Oregon
Same address
Obstetrics & Gynecology
9135 SW BARNES RD STE 761
Portland, OR 97225
  • Reassigned Medicare billing, Oregon enrollment
  • 1,501 clinicians in this Medicare group
NPI 1154427821 (503) 216-2602

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 97225 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$176.88 typical visit price
range $58.99 – $176.88
Typical copayment $44.22 (range $14.74 – $44.22)
Most-billed visit code 99205
Established Patient
$103.51 typical visit price
range $19.32 – $144.79
Typical copayment $25.87 (range $4.83 – $36.19)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

PIDO TRAN MAAS OT
Occupational Therapist
9135 SW BARNES RD STE 561
PORTLAND, OR 97225
Washington County (503) 216-2339
ALLISON M. CONNOLLY AUD
Audiologist
9135 SW BARNES RD STE 561
PORTLAND, OR 97225
Washington County (503) 216-2339
MARITZA ZALDIVAR-LIMA AU.D
Audiologist
9135 SW BARNES RD STE 561
PORTLAND, OR 97225
Washington County (503) 216-2339
DIANA DEAIBES EDDY CCC-SLP
Speech-Language Pathologist
9135 SW BARNES RD STE 561
PORTLAND, OR 97225
Washington County (503) 216-2339
ROCIO CABRERA SLP
Speech-Language Pathologist
9135 SW BARNES RD STE 561
PORTLAND, OR 97225
Washington County (503) 216-2339
MRS. TARA DARICE CENOVA M.S., CCC-SLP
Speech-Language Pathologist
9135 SW BARNES RD STE 561
PORTLAND, OR 97225
Washington County (503) 216-2339
HANNAH C FILICKY OT
Occupational Therapist
9135 SW BARNES RD STE 561
PORTLAND, OR 97225
Washington County (503) 216-2339
ELIZABETH R BRUTON PNP
Nurse Practitioner (Pediatrics)
9135 SW BARNES RD STE 561
PORTLAND, OR 97225
Washington County (503) 216-2339

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 Jack Wells's NPI number?

The NPI number for Jack Wells is 1316246937. It was assigned to this individual provider in the NPPES registry on March 22, 2011.

Where is Jack Wells located?

Jack Wells practices at 9135 SW Barnes Rd Ste 561, Portland, OR 97225. The listed phone number is (503) 216-2339.

What is Jack Wells's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Jack Wells enrolled in Medicare?

Yes. Jack Wells is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jack Wells's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jack Wells reassigns Medicare benefits to Providence Health & Services - Oregon (Portland, OR). The 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 Jack Wells's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Jack Wells accept?

Health plans from Providence Health Plan list Jack Wells 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 Jack Wells was last updated on May 13, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months 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.