Kelly Elizabeth Jackson, PT, DPT

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

62508 Issued in OR

Practice address

10100 SE Sunnyside Rd
Clackamas, OR 97015-8970

Phone

(503) 813-2000

NPI assigned

Sep 12, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR, WA2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oregon Luna Care Physical Therapy LLCGroup PAC ID 5597178087, 51 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Oregon Luna Care Physical Therapy LLC

  • Physical Therapist
  • Hillsboro, OR
  • NPI 1891397121

  Orthopedic

  Medicare reassignment Care Compare group NPD
• Kaiser Foundation Health Plan of the Northwest

  • General Practice Physician
  • Portland, OR
  • NPI 1184786527

  WA

  Medicare reassignment NPD
• North Lake Physical Therapy and Rehab LP

  • Physical Therapist
  • Lake Oswego, OR
  • NPI 1316383201
  Medicare reassignment NPD
• Kaiser Foundation Health Plan of the Northwest

  • General Practice Physician
  • Portland, OR
  • NPI 1306192455
  NPD
• Kaiser Foundation Health Plan of the Northwest

  • Clinic/Center
  • Hillsboro, OR
  • NPI 1942718622
  NPD
• Manor Care of Salmon Creek Wa, Association

  • Skilled Nursing Facility
  • Vancouver, WA
  • NPI 1609171081
  NPD

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

{
    "created_epoch": "1505174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741132800000",
    "number": "1053830968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5403 N HARVARD ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972035208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10100 SE SUNNYSIDE RD",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970158970",
            "telephone_number": "503-813-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KELLY",
        "middle_name": "ELIZABETH",
        "credential": "PT,  DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-12",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "OR",
            "license": "62508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "5403 N Harvard St",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "97203",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ruth Anne Iversen, CRNA
• Dayana Jaalouk
• Alycia Wai Lin Jackson, M.D.
• Collin Patrick Jackson, MD
• Jessica Ann Jackson, L.M.T
• Roxanne Marie Jackson, MSW, CSWA
• Sean Jackson
• Jacobs Mental Health Services
• Justin Jacobs
• Madeline Jacobs, PMHNP, RN, BSN

• Orthopedic Physical Therapist in Clackamas, OR
• Providers in Clackamas, OR by specialty
• Orthopedic Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.