HOLLY P JASTAK (RN, MSN, FNP) – Family Nurse Practitioner, NPI 1023541869
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for HOLLY P JASTAK (RN, MSN, FNP)
4399, Southeast River Drive, Glen Echo, Portland, Metro, Clackamas County, Oregon, 97267, United States
PORTLAND, OR 972084399
Phone: (503) 413-3900
Fax: (503) 413-3710
Type: Mailing
North Vancouver Avenue, Lloyd District, Portland, Metro, Multnomah County, Oregon, 97227, United States
PORTLAND, OR 972271644
Phone: (503) 413-2902
Fax: (503) 413-5220
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 10 Open Payments records for all available years, with a total value of $176.
Total Amount is formed as General ($176) + Research ($0) + Ownership ($0) = $176.
Last reported payment date: 2024-12-05 • Largest payer in this snapshot: Corium, LLC ($79).
Total Amount
$176
General + Research + Ownership
Payments
10
Total payment records
General Amount
$176
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-05
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Corium, LLC | $79 |
| AstraZeneca Pharmaceuticals LP | $59 |
| SANOFI PASTEUR INC. | $20 |
| SANOFI-AVENTIS U.S. LLC | $18 |
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: 2022-09-21
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 |
|---|---|---|---|---|
| I20190607001721 | I | Nurse Practitioner | OR | TBD |
| I20200409003901 | I | Nurse Practitioner | WA | TBD |
| I20220921001547 | I | Nurse Practitioner | AZ | 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 97208)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Endocrinology, Pediatric Medicine | OR | |
| Internal Medicine | OR | |
| Physician Assistant | OR | |
| Medical Genetics And Genomics | WA | |
| Nurse Practitioner | OR | |
| - | OR | |
| - | OR | |
| - | WA | |
| - | MN | |
| Internal Medicine | OR |
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