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JOLLY DANIEL FNP
NPI 1679205777
Nurse Practitioner - Family in Portland, OR

Active since June 28, 2022PECOS EnrolledAccepts Medicare Assignment
4805 NE GLISAN ST STE 11N, PORTLAND, OR 97213(503) 215-8650 Get Directions Write a Review

NPPES record last updated: January 2, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Jolly Daniel Fnp NPPES

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

JOLLY DANIEL FNP (NPI 1679205777) is an individual family provider in Portland, Oregon, licensed in Oregon (10031091) and active in the NPI registry since June 2022. She is enrolled in Medicare PECOS, is affiliated with Providence St Vincent Medical Center, and maintains a secondary practice location in Portland.

NPPES Registry Identity

NPI1679205777
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameJOLLY DANIELCredential: FNP
Location Address4805 NE GLISAN ST STE 11NPortland, OR 97213-2933
Mailing AddressPo Box 3158Portland, OR 97208-3158 · (503) 215-6494
Phone(503) 215-8650
Sole ProprietorNo
Medical School CMSOtherGraduated 2004
Enumeration DateJune 28, 2022
Last NPPES UpdateJanuary 2, 2025
NPPES CertifiedJanuary 2, 2025
✔ NPI 1679205777 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in OR · 10031091
4805 NE GLISAN ST STE 11N, Portland, OR 97213
Open in Google Maps ↗

Secondary Practice Location 1

Location 14097 NW 176th AvePortland, OR 97229-3088 · Phone (503) 784-0743

Accepted Insurance

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

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jolly Daniel Fnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9234665746
PECOS Enrollment IDI20241206003551
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

3

Medicare enrollment records show Jolly Daniel reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Providence Health & Services - Oregon
Same address
General Acute Care Hospital
4805 NE GLISAN ST
Portland, OR 97213
  • Reassigned Medicare billing, Oregon enrollment
  • 676 clinicians in this Medicare group
NPI 1003991845 (503) 451-3000
Providence Health & Services - Oregon
Same address
Hematology & Oncology
4805 NE GLISAN ST STE 11N
Portland, OR 97213
  • Reassigned Medicare billing, Oregon enrollment
  • 1,501 clinicians in this Medicare group
NPI 1316197692 (503) 215-5696
Providence Health & Services - Oregon
7.9 mi
Clinic/Center
9205 SW BARNES RD, SUITE 20
Portland, OR 97225
  • Reassigned Medicare billing, Oregon enrollment
  • 753 clinicians in this Medicare group
NPI 1235259532 (503) 216-2229

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

Hospital Affiliations CMS Care Compare 5

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Providence St Vincent Medical Center

Acute Care Hospitals · Portland, OR
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number380004
Location9205 SW Barnes RoadPortland, OR 97225 · Washington County
Emergency services Birthing friendly

Providence Newberg Medical Center

Acute Care Hospitals · Newberg, OR
3/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number380037
Location1001 Providence DriveNewberg, OR 97132 · Yamhill County
Emergency services Birthing friendly

Providence Portland Medical Center

Acute Care Hospitals · Portland, OR
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number380061
Location4805 NE Glisan StreetPortland, OR 97213 · Multnomah County
Emergency services Birthing friendly

Providence Seaside Hospital

Critical Access Hospitals · Seaside, OR
OwnershipVoluntary non-profit - Church
CMS Certification Number381303
Location725 S Wahanna RoadSeaside, OR 97138 · Clatsop County
Emergency services Birthing friendly

Providence Hood River Memorial Hospital

Critical Access Hospitals · Hood River, OR
4/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number381318
Location810 12th StreetHood River, OR 97031 · Hood River County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 97213 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
$90.51 typical visit price
range $58.99 – $176.88
Typical copayment $22.62 (range $14.74 – $44.22)
Most-billed visit code 99203
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.

PROVIDENCE HEALTH & SERVICES - OREGON
Obstetrics & Gynecology
4805 NE GLISAN ST STE 11N
PORTLAND, OR 97213
Multnomah County (503) 215-2075
RHEZARIE MAE A AGTARAP NP-C
Nurse Practitioner (Gerontology)
4805 NE GLISAN ST STE 11N
PORTLAND, OR 97213
Multnomah County (503) 215-1350
DR. HEIDI J HANSEN D.M.D.
Oral Medicine
4805 NE GLISAN ST STE 11N
PORTLAND, OR 97213
Multnomah County (503) 215-1676
REBECCA T ARMENDARIZ MD
Internal Medicine (Hospice and Palliative Medicine)
4805 NE GLISAN ST STE 11N
PORTLAND, OR 97213
Multnomah County (503) 215-1350
PROVIDENCE HEALTH & SERVICES - OREGON
Internal Medicine (Hematology & Oncology)
4805 NE GLISAN ST STE 11N
PORTLAND, OR 97213
Multnomah County (503) 215-1600
MATTHEW HIRAM TAYLOR MD
Internal Medicine (Medical Oncology)
4805 NE GLISAN ST STE 11N
PORTLAND, OR 97213
Multnomah County (503) 215-1350
MOLLY CHRISTINE DAVIS ANP
Nurse Practitioner (Gerontology)
4805 NE GLISAN ST STE 11N
PORTLAND, OR 97213
Multnomah County (503) 215-1350
DIANA DENTON ZELLNER D.O.
Internal Medicine (Hospice and Palliative Medicine)
4805 NE GLISAN ST STE 11N
PORTLAND, OR 97213
Multnomah County (503) 215-1350

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 Jolly Daniel's NPI number?

The NPI number for Jolly Daniel is 1679205777. It was assigned to this individual provider in the NPPES registry on June 28, 2022.

Where is Jolly Daniel located?

Jolly Daniel practices at 4805 NE Glisan St Ste 11N, Portland, OR 97213. The listed phone number is (503) 215-8650.

What is Jolly Daniel's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Jolly Daniel enrolled in Medicare?

Yes. Jolly Daniel is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Jolly Daniel's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jolly Daniel reassigns Medicare benefits to 3 organizations: Providence Health & Services - Oregon (Portland, OR), Providence Health & Services - Oregon (Portland, OR) and Providence Health & Services - Oregon (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 Jolly Daniel's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Jolly Daniel accept?

Health plans from Moda Health Plan, Inc. list Jolly Daniel 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.

Is Jolly Daniel affiliated with any hospitals?

According to CMS data, Jolly Daniel is affiliated with Providence St Vincent Medical Center, Providence Newberg Medical Center, Providence Portland Medical Center, Providence Seaside Hospital and Providence Hood River Memorial Hospital.

When was this NPI record last updated?

The NPPES record for Jolly Daniel was last updated on January 2, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 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.