Individual provider Active NPI

Kristin Lois Cummings, RN

  • Psychiatric/Mental Health Nurse Practitioner
  • Portland, OR
National Provider Identifier
1013190081
Registry record updated Mar 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
201250003NP Issued in OR
Practice address
5329 NE Martin Luther King Blvd
Portland, OR 97211-3237
Phone
(503) 988-5183
Fax
(503) 988-5182
NPI assigned
Dec 12, 2007
Last updated
Mar 9, 2017By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 9, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 201250003NP OR Primary
Psychiatric/Mental Health Registered Nurse 163WP0808X 201040123RN OR

Addresses

Primary practice location

5329 NE Martin Luther King Blvd
Portland, OR 97211-3237

Mailing address

421 SW Oak St
Ste. 210
Portland, OR 97204-1817
Phone (503) 988-7468

Other identifiers 2

IdentifierTypeStateIssuer
022959MedicaidOR
096511MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130613000615 OR Practitioner - Nurse Practitioner 8426297961 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Multnomah CountyGroup PAC ID 6608771787, 111 clinicians

Practice addresses (Care Compare)

5329 NE Martin Luther King Blvd
Northeast Health Center
Portland, OR 97212-3237
Phone (503) 988-5183

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Multnomah County Current Accepting new patients
Mulnomah County CurrentSince Feb 25, 2017 Accepting new patients
Multnomah County CurrentSince Feb 25, 2017 Accepting new patients

Locations

600 NE 8th St
Gresham, OR 97030
Phone (503) 988-4900

209 SW 4th Ave
Ste 210
Portland, OR 97204
Phone (503) 988-3674

5329 NE Mlk Jr Blvd
Portland, OR 97211
Phone (503) 988-3821

Interoperability endpoints

  • Direct secure messaging: kcummings196525@direct.ochin.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1197417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489017600000",
    "number": "1013190081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 SW OAK ST",
            "address_2": "STE. 210",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972041817",
            "telephone_number": "503-988-7468",
            "fax_number": "503-988-3015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5329 NE MARTIN LUTHER KING BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972113237",
            "telephone_number": "503-988-5183",
            "fax_number": "503-988-5182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUMMINGS",
        "first_name": "KRISTIN",
        "middle_name": "LOIS",
        "name_prefix": "Miss",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-12-12",
        "last_updated": "2017-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "201250003NP",
            "primary": true
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "OR",
            "license": "201040123RN",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022959",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "096511",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.