JACOB HENRY NELSON (DO) – Dermatology Physician, NPI 1568920882
Dermatology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for JACOB HENRY NELSON (DO)
3303 S Bond Ave
Portland, OR 972394501
Phone: (360) 831-3123
Type: Location
3303 S BOND AVE
PORTLAND, OR 972394501
Phone: (360) 831-3123
Type: Mailing
College of Osteopathic Medicine of the Pacific-Northwest, 200, Mullins Drive, Lebanon, Linn County, Oregon, 97355, United States
LEBANON, OR 973553983
Phone: (541) 259-0200
Type: Mailing
4764 GLENALLEN CT NE
SALEM, OR 973053030
Phone: (360) 831-3123
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $25.
Total Amount is formed as General ($25) + Research ($0) + Ownership ($0) = $25.
Last reported payment date: 2024-09-24 • Largest payer in this snapshot: UCB, Inc. ($25).
Total Amount
$25
General + Research + Ownership
Payments
1
Total payment records
General Amount
$25
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-09-24
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| UCB, Inc. | $25 |
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: 2022-12-29
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
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 |
|---|---|---|---|---|
| I20221229001476 | I | Dermatology | OR | 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 97239)
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