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JACK R AGEN MA
NPI 1902960362
Counselor - Professional in Gladstone, OR

Active since December 20, 2006PECOS Enrolled
880 82ND DR, GLADSTONE, OR 97027(503) 659-5515(503) 659-1994 Get Directions Write a Review

NPPES record last updated: July 9, 2007. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Jack R Agen Ma NPPES

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

JACK R AGEN MA (NPI 1902960362) is an individual professional provider in Gladstone, Oregon, licensed in Oregon (C1077) and active in the NPI registry since December 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1902960362
Entity TypeIndividualMale
Primary Taxonomy101YP2500X
Provider Legal NameJACK R AGENCredential: MA
Location Address880 82ND DRGladstone, OR 97027-1803
Mailing AddressPo Box 82819Portland, OR 97282-0819 · (503) 233-5405 · Fax (503) 233-2696
Phone(503) 659-5515
Fax(503) 659-1994
Sole ProprietorNo
Enumeration DateDecember 20, 2006
Last NPPES UpdateJuly 9, 2007
✔ NPI 1902960362 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 · C1077
880 82ND DR, Gladstone, OR 97027
Open in Google Maps ↗

Other Identifiers 2

Medicare ID-Type Unspecified0000WDBCHOR · Group Number
Medicaid164936OR

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Kaiser Permanente, Moda Health Plan, Inc. and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jack R Agen Ma 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.

SARAH MILLER LPC
Counselor (Professional)
880 82ND DR
GLADSTONE, OR 97027
Clackamas County (503) 659-5515
JOSCELYN BEEBE
Case Manager/Care Coordinator
880 82ND DR
GLADSTONE, OR 97027
Clackamas County (971) 378-0367
RYAN MICHAEL WILCOX LMFT
Marriage & Family Therapist
880 82ND DR
GLADSTONE, OR 97027
Clackamas County (503) 659-5515
MS. BARBARA COLLINS
Counselor (Addiction (Substance Use Disorder))
880 82ND DR, ANNEX A
GLADSTONE, OR 97027
Clackamas County (503) 659-5515
MRS. KATHLEEN M. CLANTON LMFT
Marriage & Family Therapist
880 82ND DR
GLADSTONE, OR 97027
Clackamas County (503) 659-5515
ALEXANDRA ANNE EMMERT LPC
Counselor (Professional)
880 82ND DR
GLADSTONE, OR 97027
Clackamas County (971) 378-0367
DENNIS SWEENEY LPC, CADC II
Counselor (Addiction (Substance Use Disorder))
880 82ND DR, WESTERN PSYCHOLOGICAL AND COUNSELING SERVICES
GLADSTONE, OR 97027
Clackamas County (503) 659-5515
SARAH GILES
Counselor (Mental Health)
880 82ND DR
GLADSTONE, OR 97027
Clackamas County (971) 378-0367

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 Jack Agen's NPI number?

The NPI number for Jack Agen is 1902960362. It was assigned to this individual provider in the NPPES registry on December 20, 2006.

Where is Jack Agen located?

Jack Agen practices at 880 82nd Dr, Gladstone, OR 97027. The listed phone number is (503) 659-5515.

What is Jack Agen's specialty?

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

Is Jack Agen enrolled in Medicare?

Yes. Jack Agen is registered in the Medicare PECOS enrollment system.

What insurance does Jack Agen accept?

Health plans from BridgeSpan Health Company, Kaiser Permanente, Moda Health Plan, Inc., PacificSource Health Plans and Providence Health Plan and 1 other insurer list Jack Agen 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 Jack Agen was last updated on July 9, 2007. NPI Profile syncs with the weekly NPPES data releases published by CMS.