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JACY A. STAUFFER D.M.D.
NPI 1699974014
Dentist - Pediatric Dentistry in Portland, OR

Active since July 16, 2007PECOS Enrolled
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239(503) 418-5799(503) 418-4750 Get Directions Write a Review

NPPES record last updated: November 10, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Jacy A. Stauffer D.m.d. NPPES

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

JACY A. STAUFFER D.M.D. (NPI 1699974014) is an individual pediatric dentistry provider in Portland, Oregon, licensed in Oregon (DF0053) and active in the NPI registry since July 2007. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1699974014
Entity TypeIndividualFemale
Primary Taxonomy1223P0221X
Provider Legal NameJACY A. STAUFFERCredential: D.M.D.
Location Address3181 SW SAM JACKSON PARK RDPortland, OR 97239-3011
Mailing Address3181 Sw Sam Jackson Park RdPortland, OR 97239-3011 · (503) 418-5799 · Fax (503) 418-4750
Phone(503) 418-5799
Fax(503) 418-4750
Sole ProprietorNo
Enumeration DateJuly 16, 2007
Last NPPES UpdateNovember 10, 2022
NPPES CertifiedNovember 10, 2022
✔ NPI 1699974014 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers
Taxonomy Code1223P0221X
Licenses✔ Licensed in OR · DF0053✔ Licensed in MD · LL738
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
3181 SW SAM JACKSON PARK RD, Portland, OR 97239
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Other Identifiers 1

Medicaid119591300MD

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BEST Life, BridgeSpan Health Company, Dominion National and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jacy A. Stauffer D.m.d. 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 Jacy Stauffer reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

University Professional Services
Same address
General Practice
3181 SW SAM JACKSON PARK RD
Portland, OR 97239
  • Reassigned Medicare billing, Oregon enrollment
  • 2,212 clinicians in this Medicare group
NPI 1376709535 (503) 494-8311

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 97239 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
$73.28 typical visit price
range $19.32 – $144.79
Typical copayment $18.32 (range $4.83 – $36.19)
Most-billed visit code 99213
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.

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 Jacy Stauffer's NPI number?

The NPI number for Jacy Stauffer is 1699974014. It was assigned to this individual provider in the NPPES registry on July 16, 2007.

Where is Jacy Stauffer located?

Jacy Stauffer practices at 3181 SW Sam Jackson Park Rd, Portland, OR 97239. The listed phone number is (503) 418-5799.

What is Jacy Stauffer's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

Is Jacy Stauffer enrolled in Medicare?

Yes. Jacy Stauffer is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jacy Stauffer's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jacy Stauffer reassigns Medicare benefits to University Professional Services (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 Jacy Stauffer's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Jacy Stauffer accept?

Health plans from BEST Life, BridgeSpan Health Company, Dominion National, HRI Dental & Vision and Humana and 6 other insurers list Jacy Stauffer 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 Jacy Stauffer was last updated on November 10, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.