Active NPI
Kellie Young
- Gastroenterology Physician
- Portland, OR
National Provider Identifier
1073908588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- MD186857
- Practice address
- 1130 NW 22ND Ave Ste 410
Portland, OR 97210-2911 - Phone
- (503) 229-7137
- NPI assigned
- Apr 1, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | MD186857 | OR | Primary |
Addresses
Primary practice location
1130 NW 22ND Ave Ste 410
Portland, OR 97210-2911
Mailing address
1130 NW 22ND Ave Ste 410
Portland, OR 97210-2911
Other practice location 1
751 S Bascom Ave
San Jose, CA 95128-2604
Phone (808) 728-5020
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: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Gastroenterology
- Education
- University of California, San Francisco School of Medicine, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
1130 NW 22ND Ave
Suite 410
Portland, OR 97210-2911
Phone (503) 229-7137
Hospital & facility affiliations
- Legacy Good Samaritan Medical Center
- Legacy Emanuel Medical Center
- Ohsu Hospital and Clinics
Merit-based Incentive Payment System (MIPS)
- Final score
- 88.8 of 100
- Quality
- 83.56
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 76.68
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Colonoscopy | 35 |
| Upper gastrointestinal (GI) endoscopy for acid reflux | 65 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD186857 | OR | MD | Gastroenterology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwest Gastroenterology Clinic LLC | Single Specialty | Current | Accepting new patients |
| NGC Endoscopy Services LLC | Current | Accepting new patients |
Locations
1130 NW 22nd Ave
Ste 410
Portland, OR 97210
Phone (503) 229-7137
501 N Graham St
Ste 465
Portland, OR 97227
Interoperability endpoints
- kyoung629014@direct.lhs.org
Organizations & group practices 2
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.
-
- Ambulatory Surgical Clinic/Center
- Portland, OR
- NPI 1366529638
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Portland, OR
- NPI 1003367491
-
- Clinical Medical Laboratory
- Portland, OR
- NPI 1295756898
Hospital
-
- General Acute Care Hospital
- Portland, OR
- NPI 1831112358
-
- Clinic/Center
- Portland, OR
- NPI 1679597108
Hospital
-
- General Acute Care Hospital
- Portland, OR
- NPI 1780608216
-
- General Acute Care Hospital
- Portland, OR
- NPI 1609824010
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1427846400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623801600000",
"number": "1073908588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1130 NW 22ND AVE STE 410",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972102911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1130 NW 22ND AVE STE 410",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972102911",
"telephone_number": "503-229-7137"
}
],
"practiceLocations": [
{
"address_1": "751 S Bascom Ave",
"address_purpose": "LOCATION",
"city": "San Jose",
"state": "CA",
"postal_code": "951282604",
"country_code": "US",
"telephone_number": "808-728-5020",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "YOUNG",
"first_name": "KELLIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-04-01",
"last_updated": "2021-06-16",
"certification_date": "2021-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine, Gastroenterology",
"state": "OR",
"license": "MD186857",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.