Brisa Salome Jessup, NP is a medicare enrolled "Nurse Practitioner - Pediatrics" physician in Portland, Oregon. Her current practice location is
2801 N Gantenbein Ave Fl 5, Portland, Oregon. You can reach out to her office (for appointments etc.) via phone at
(502) 276-6500.
Brisa Salome Jessup is licensed to practice in Oregon (license number 10008584) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1578255741.
Physician's Profile
| Full Name | Brisa Salome Jessup |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Pediatrics |
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| Location | 2801 N Gantenbein Ave Fl 5, 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: 1578255741
- Provider Enumeration Date: 05/24/2023
- Last Update Date: 07/17/2023
Medicare PECOS Information:
- PECOS PAC ID: 7113388554
- Enrollment ID: I20230801002309
Medical Identifiers
Medical identifiers for Brisa Salome Jessup such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1578255741 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 2080P0203X | Pediatrics - Pediatric Critical Care Medicine | 10008584 (Oregon) | Secondary |
| 363LP0222X | Nurse Practitioner - Pediatrics, Critical Care | 10008584 (Oregon) | Secondary |
| 363LP0200X | Nurse Practitioner - Pediatrics | 10008584 (Oregon) | 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. Brisa Salome Jessup allows following entities to bill medicare on her behalf.
| Entity Name | Legacy Emanuel Hospital & Health Center |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1831112358
PECOS PAC ID: 4587573639
Enrollment ID: O20040127001204 |
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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. Brisa Salome Jessup 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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Brisa Salome Jessup, NP
3166 Oak Tree Ct,
West Linn, OR 97068-2324
Ph: (541) 400-9630 | Brisa Salome Jessup, NP
2801 N Gantenbein Ave Fl 5,
Portland, OR 97227-1623
Ph: (502) 276-6500 |
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