Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jacob Geyen

Individual provider Physician Assistant · NPI 1770284481

Jacob Geyen is a Physician Assistant in Portland, Oregon. Qualified in 2023, 3 years ago. Practices with Legacy Clinics LLC, a 718-clinician group and accepts Medicare assignment. Licensed in Oregon.

Years since qualifying
3
Licensed in
OR
In the registry since
2023
Specialties on file
2
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Practice location Address checks out

2801 N Gantenbein Ave
Portland, OR 97227-1623
Phone: (503) 413-2200
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA217971 (OR)
Physician Assistant Taxonomy 363A00000X

Record details

NPI number1770284481
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 10, 2023
Last updated in NPPESNovember 6, 2023
Certification dateNovember 6, 2023
Mailing address14905 Sw 106th Ave, Tigard, OR 97224-4754

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Legacy Clinics Llc — 718 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations8 on file with Medicare

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