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JACOB KELLY SMITH MD
NPI 1508457300
Student in an Organized Health Care Education/Training Program in Portland, OR

Active since February 03, 2021PECOS Enrolled
9205 SW BARNES RD, PORTLAND, OR 97225(503) 216-2621 Get Directions Write a Review

NPPES record last updated: June 18, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jun 18, 2023, Feb 3, 2021 (2 updates tracked since 2021).

About Jacob Kelly Smith Md NPPES

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

JACOB KELLY SMITH MD (NPI 1508457300) is an individual student in an organized health care education/training program in Portland, Oregon, licensed in Oregon (PG215454) and active in the NPI registry since February 2021. He is enrolled in Medicare PECOS and maintains a secondary practice location in Portland.

NPPES Registry Identity

NPI1508457300
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameJACOB KELLY SMITHCredential: MD
Location Address9205 SW BARNES RDPortland, OR 97225-6603
Mailing AddressPo Box 3158Portland, OR 97208-3158 · (503) 215-6494
Phone(503) 216-2621
Sole ProprietorNo
Enumeration DateFebruary 3, 2021
Last NPPES UpdateJune 18, 20232 updates tracked since enumeration
NPPES CertifiedJune 18, 2023
✔ NPI 1508457300 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
License✔ Licensed in OR · PG215454
Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

9205 SW BARNES RD, Portland, OR 97225
Open in Google Maps ↗

Other Names 1

Other Name (5)Jake Smith

Secondary Practice Location 1

Location 13181 SW Sam Jackson Park RdPortland, OR 97239-3011 · Phone (503) 860-3996

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jacob Kelly Smith 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.

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.

DR. VICTOR NGUYEN PHAM M.D.
Hospitalist
9205 SW BARNES RD
PORTLAND, OR 97225
Washington County (503) 216-2906
YEVGENY BULOCHNIK PHARMD
Pharmacist
9205 SW BARNES RD
PORTLAND, OR 97225
Washington County (503) 216-3299
MR. DANIEL PAUL ADDY C.R.N.A.
Nurse Anesthetist, Certified Registered
9205 SW BARNES RD
PORTLAND, OR 97225
Washington County (503) 216-1234
MR. JONATHAN DAVID CAULLEY PT
Physical Therapist
9205 SW BARNES RD
PORTLAND, OR 97225
Washington County (503) 216-2610
EMILY ECHTENKAMP LCSW, CADC III, MAC
Counselor (Mental Health)
9205 SW BARNES RD
PORTLAND, OR 97225
Washington County (503) 216-1234
BRIAN J KEARNS MD
Hospitalist
9205 SW BARNES RD
PORTLAND, OR 97225
Washington County (503) 216-2906
DR. JAMES S PUTNAM MD
Radiology (Vascular & Interventional Radiology)
9205 SW BARNES RD
PORTLAND, OR 97225
Washington County (503) 216-4830
MATTHEW CARSTENS FRANK M.D.
Pathology (Anatomic Pathology & Clinical Pathology)
9205 SW BARNES RD
PORTLAND, OR 97225
Washington County (303) 859-4275

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 Jacob Smith's NPI number?

The NPI number for Jacob Smith is 1508457300. It was assigned to this individual provider in the NPPES registry on February 3, 2021. The provider is also known as Jake Smith.

Where is Jacob Smith located?

Jacob Smith practices at 9205 SW Barnes Rd, Portland, OR 97225. The listed phone number is (503) 216-2621.

What is Jacob Smith's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Jacob Smith enrolled in Medicare?

Yes. Jacob Smith is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jacob Smith was last updated on June 18, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.