JENNIFER LYN WALLACE MD
NPI 1730154154
Family Medicine in Portland, OR
NPI Status: Active since February 20, 2006
Contact Information
1235 SE DIVISION ST
SUITE 208
PORTLAND, OR
ZIP 97202
Phone: (888) 480-1115
- Individual
- Female
- Family Medicine
- Accepts Insurance
- PECOS Enrolled
- Opted-Out Medicare
- CLIA Number: 38D1104174
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 08-25-2027
About JENNIFER WALLACE
This page provides the complete NPI Profile along with additional information for Jennifer Wallace, a primary care provider established in Portland, Oregon with a medical specialization in Family Medicine. The healthcare provider is registered in the NPI registry with number 1730154154 assigned on February 2006. The practitioner's primary taxonomy code is 207Q00000X with license number MD24427 (OR). The provider is registered as an individual and her NPI record was last updated 18 years ago.
- NPI
- 1730154154
- Provider Name
- JENNIFER LYN WALLACE MD
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 1235 SE DIVISION ST SUITE 208 PORTLAND, OR 97202
- Location Phone
- (888) 480-1115
- Mailing Address
- 1235 SE DIVISION ST SUITE 208 PORTLAND, OR 97202
- Mailing Phone
- (888) 480-1115
- Is Sole Proprietor?
- Yes
- Enumeration Date
- 02-20-2006
- Last Update Date
- 03-18-2008
- Code Navigator
A primary care provider (PCP) like Jennifer Wallace sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .
The provider doesn't accept Medicare and has signed an affidavit to be excluded from the Medicare program. If you are a Medicare beneficiary this means a provider can charge whatever they want for services rendered but must follow certain rules to do so. Jennifer Wallace opted out of Medicare effective on 05-19-2017 until 05-19-2027. Opt out periods last for two years and cannot be terminated unless the provider is opting out for the very first time and the affidavit is terminated no later than 90 days after the opt out effective date. Opt-out affidavits might renew automatically renew every two years. The provider opted out of Medicare but is permitted to order and refer services to other healthcare providers.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Family Medicine
- Taxonomy Code
- 207Q00000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- MD24427
- License State
- OR
- Taxonomy Description
- Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- HSA-E Qualified 7500 Bronze - Signature Network - EPO
- Providence Oregon Standard Bronze Plan - Signature Network - EPO
- Providence Oregon Standard Gold Plan - Signature Network - EPO
- Providence Oregon Standard Silver Plan - Signature Network - EPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 232919 | MEDICAID (05) | OR | |
| I02430 | MEDICARE UPIN (02) | OR |
Medicare Participation & PECOS Enrollment Status
Jennifer Wallace is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
Opted-Out of Medicare? Yes
Opt-Out Effective Date: 05-19-2017
Opt-Out End Date: 05-19-2027
Eligible to Order and Refer? Yes
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
Physician Visit Costs
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 97202 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99203
- Average New Patient Price $90.51
- Minimum New Patient Price $58.99
- Maximum New Patient Price $176.88
- Average New Patient Copayment $22.62
- Minimum New Patient Copayment $14.74
- Maximum New Patient Copayment $44.22
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99214
- Average Established Patient Price $103.51
- Minimum Established Patient Price $19.32
- Maximum Established Patient Price $144.79
- Average Established Patient Copayment $25.87
- Minimum Established Patient Copayment $4.83
- Maximum Established Patient Copayment $36.19
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 38D1104174
- Facility Type
- Physician Office
- Certificate Effective Date
- August 26, 2025
- Certificate Expiration Date
- August 25, 2027
- Laboratory Director
- JENNIFER L. WALLACE
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Jennifer Wallace to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1730154154, we treat the final digit (4) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 56. The final step is to find the difference between that total and the next multiple of ten (60 - 56 = 4).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 56 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 20 providers are registered at the same or a nearby location.
PORTLAND, OR 97202
PORTLAND, OR 97202
PORTLAND, OR 97202
PORTLAND, OR 97202
PORTLAND, OR 97202
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1730154154, enumerated as an "individual" on February 20, 2006.
The provider is located at 1235 SE DIVISION ST SUITE 208 PORTLAND, OR 97202 and the phone number is (888) 480-1115.
Family Medicine with taxonomy code 207Q00000X.
The provider might be accepting Accepts: Providence Health Plan, Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
