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JASON DAVID WALLIS LPC
NPI 1396913331
Counselor - Professional in Portland, OR

Active since February 12, 2008PECOS Enrolled
2901 E BURNSIDE ST, PORTLAND, OR 97214(503) 953-0310 Get Directions Write a Review

NPPES record last updated: April 17, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Sep 5, 2024, May 22, 2023, Sep 4, 2020 and 1 more (4 updates tracked since 2017).

About Jason David Wallis Lpc NPPES

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

JASON DAVID WALLIS LPC (NPI 1396913331) is an individual professional provider in Portland, Oregon, licensed in Oregon (C7443) and active in the NPI registry since February 2008. He is enrolled in Medicare PECOS, maintains a secondary practice location in Portland, and is a graduate of Other (2020).

NPPES Registry Identity

NPI1396913331
Entity TypeIndividualMale
Primary Taxonomy101YP2500X
Provider Legal NameJASON DAVID WALLISCredential: LPC
Location Address2901 E BURNSIDE STPortland, OR 97214-1831
Mailing Address3500 Ne Martin Luther King Jr Blvd Ste 200Portland, OR 97212-2093 · (503) 655-8264 · Fax (503) 953-2454
Phone(503) 953-0310
Sole ProprietorNo
Medical School CMSOtherGraduated 2020
Enumeration DateFebruary 12, 2008
Last NPPES UpdateApril 17, 20254 updates tracked since enumeration
NPPES CertifiedApril 17, 2025
✔ NPI 1396913331 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in OR · C7443
2901 E BURNSIDE ST, Portland, OR 97214
Open in Google Maps ↗

Secondary Practice Location 1

Location 13500 NE Martin Luther King Jr Blvd Ste 200Portland, OR 97212-2093 · Phone (503) 496-3201

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc., 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)

Jason David Wallis Lpc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID941745822
PECOS Enrollment IDI20240716000981
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 Jason Wallis reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Kaiser Foundation Health Plan Of The Northwest
0.8 mi
General Practice
3060 SE HAWTHORNE BLVD
Portland, OR 97214
  • Reassigned Medicare billing, Oregon enrollment
  • 3,207 clinicians in this Medicare group
NPI 1063990695 (800) 813-2000

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

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.

MS. AUTUMN BROWN CADC I
Counselor (Addiction (Substance Use Disorder))
2901 E BURNSIDE ST
PORTLAND, OR 97214
Multnomah County (503) 238-5203
MRS. BRIDGET ANN BROOKS LCSW
Social Worker (Clinical)
2901 E BURNSIDE ST
PORTLAND, OR 97214
Multnomah County (503) 238-5203
KENT DAIL
Counselor (Professional)
2901 E BURNSIDE ST
PORTLAND, OR 97214
Multnomah County (503) 953-0310
CHRISTOPHER A VAUGHN
Counselor (Addiction (Substance Use Disorder))
2901 E BURNSIDE ST
PORTLAND, OR 97214
Multnomah County (503) 238-5203
DANIELLE MAY DEER MA, CADC2
Counselor (Addiction (Substance Use Disorder))
2901 E BURNSIDE ST
PORTLAND, OR 97214
Multnomah County (503) 238-5203
VANESSA KNIGHT
Counselor (Professional)
2901 E BURNSIDE ST
PORTLAND, OR 97214
Multnomah County (503) 953-0310
EVELYN SANDHIYA CHAMBERS
Peer Specialist
2901 E BURNSIDE ST
PORTLAND, OR 97214
Multnomah County (503) 238-5203
SUNDAURA LITHMAN MSW, CSWA
Counselor (Mental Health)
2901 E BURNSIDE ST
PORTLAND, OR 97214
Multnomah County (503) 238-5203

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 Jason Wallis's NPI number?

The NPI number for Jason Wallis is 1396913331. It was assigned to this individual provider in the NPPES registry on February 12, 2008.

Where is Jason Wallis located?

Jason Wallis practices at 2901 E Burnside St, Portland, OR 97214. The listed phone number is (503) 953-0310.

What is Jason Wallis's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Jason Wallis enrolled in Medicare?

Yes. Jason Wallis is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jason Wallis's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jason Wallis reassigns Medicare benefits to Kaiser Foundation Health Plan Of The Northwest (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 Jason Wallis's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Jason Wallis accept?

Health plans from Moda Health Plan, Inc. and Providence Health Plan list Jason Wallis 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 Jason Wallis was last updated on April 17, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.