Jesse Wayne Coburn, LSCW, CADC II, SUDP is a medicare enrolled "Social Worker - Clinical" provider in Portland, Oregon. His current practice location is
5257 Ne Mlk Jr Blvd Ste 201, Portland, Oregon. You can reach out to his office (for appointments etc.) via phone at
(503) 954-2077.
Jesse Wayne Coburn is licensed to practice in Washington (license number LW61327515) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1902463086.
Healthcare Provider's Profile
| Full Name | Jesse Wayne Coburn |
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| Gender | Male |
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| Speciality | Social Worker - Clinical |
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| Location | 5257 Ne Mlk Jr Blvd Ste 201, Portland, Oregon |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1902463086
- Provider Enumeration Date: 05/23/2019
- Last Update Date: 06/12/2025
Medicare PECOS Information:
- PECOS PAC ID: 4688060593
- Enrollment ID: I20230912004355
Medical Identifiers
Medical identifiers for Jesse Wayne Coburn such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1902463086 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YA0400X | Counselor - Addiction (substance Use Disorder) | CP61374175 (Washington) | Secondary |
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 19-10-32 (Oregon) | Secondary |
| 1041C0700X | Social Worker - Clinical | L10830 (Oregon) | Secondary |
| 1041C0700X | Social Worker - Clinical | LW61327515 (Washington) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jesse Wayne Coburn allows following entities to bill medicare on his behalf.
| Entity Name | Deborah A Christensen Phd & Associates, Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1891955936
PECOS PAC ID: 6901891498
Enrollment ID: O20040415000323 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jesse Wayne Coburn is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Jesse Wayne Coburn, LSCW, CADC II, SUDP
371 E Cronquist Rd,
Allyn, WA 98524-8745
Ph: (208) 404-1501 | Jesse Wayne Coburn, LSCW, CADC II, SUDP
5257 Ne Mlk Jr Blvd Ste 201,
Portland, OR 97211-3283
Ph: (503) 954-2077 |
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