Active NPI
Shawn Kerr, B.S.
- Student in an Organized Health Care Education/Training Program
- Portland, OR
National Provider Identifier
1073949772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- 171M00000X
- Practice address
- 9911 SE Mount Scott Blvd
Portland, OR 97266-6302 - Phone
- (503) 258-4200
- NPI assigned
- Sep 25, 2013
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 171M00000X | OR | Primary |
Addresses
Primary practice location
9911 SE Mount Scott Blvd
Portland, OR 97266-6302
Mailing address
10325 NE Hancock St Apt 18
Portland, OR 97220-3833
Phone (907) 350-6202
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 171M00000X | OR | MD | Case Manager/Care Coordinator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1380067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380067200000",
"number": "1073949772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10325 NE HANCOCK ST APT 18",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972203833",
"telephone_number": "907-350-6202"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9911 SE MOUNT SCOTT BLVD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972666302",
"telephone_number": "503-258-4200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KERR",
"first_name": "SHAWN",
"credential": "B.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-09-25",
"last_updated": "2013-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "OR",
"license": "171M00000X",
"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 Sep 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.