JESSE WILLIAM LOUGHLIN (MD) – Emergency Medicine Physician, NPI 1114555786
Emergency Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
164 SPORTS MEDICINE in MA
Provider Addresses for JESSE WILLIAM LOUGHLIN (MD)
330 BROOKLINE AVE
BOSTON, MA 022155400
Phone: (617) 667-7000
Type: Mailing
2111 EXCHANGE ST
ASTORIA, OR 971033329
Phone: (503) 325-4321
Type: Mailing
3181 SW Sam Jackson Park Rd
Portland, OR 972393098
Phone: (503) 494-8211
Type: Location
700 NE 87th Ave Ste 120
Vancouver, WA 986644896
Phone: (360) 882-2778
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-01-30
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20230606001692 | I | Sports Medicine | MA | TBD |
| I20240801003054 | I | Emergency Medicine | OR | TBD |
| I20250130001655 | I | Sports Medicine | WA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 02215)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | AZ | |
| Orthopedic Surgery | IA | |
| Pulmonary Disease | OR | |
| - | OR | |
| Nurse Practitioner | OR | |
| Certified Registered Nurse Anesthetist (Crna) | MO | |
| Emergency Medicine | WA | |
| O B S T E T R I C S/ G Y N E C O L O G Y | WA | |
| Diagnostic Radiology | ME | |
| - | CO |
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