NPIMap

Individual provider Active NPI

Kimberly A Shields, DO

  • Family Medicine Physician
  • Portland, OR
National Provider Identifier
1104841543
Registry record updated Oct 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO25452 Issued in OR
Practice address
1321 NE 99TH Ave
Suite 200
Portland, OR 97220-9436
Phone
(503) 215-4250
Fax
(503) 215-4255
NPI assigned
Jul 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DO25452 OR Primary

Addresses

Primary practice location

1321 NE 99TH Ave
Suite 200
Portland, OR 97220-9436

Mailing address

PO Box 3158
Portland, OR 97208-3158

Other identifiers 1

IdentifierTypeStateIssuer
023123MedicaidOR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kshields117807@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050912000151 OR Practitioner - Family Practice 1951334952 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Texas HSC, College of Osteopathic Med, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Advanced Internal Medicine Group PCGroup PAC ID 7214235258, 7 clinicians

Practice addresses (Care Compare)

9555 SW Barnes Rd
Suite 255
Portland, OR 97225-6654
Phone (503) 908-1590

Hospital & facility affiliations

  • Providence St Vincent Medical Center Hospital, Portland, OR, CCN 380004
  • Providence Portland Medical Center Hospital, Portland, OR, CCN 380061
  • Ohsu Hospital and Clinics Hospital, Portland, OR, CCN 380009
  • Legacy Good Samaritan Medical Center Hospital, Portland, OR, CCN 380017

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
DO25452ORMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Internal Medicine Group, PC CurrentSince Jul 29, 2024 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services - Oregon Family Medicine CurrentSince May 23, 2011 Accepting new patients

Locations

1321 NE 99th Ave
Ste 100
Portland, OR 97220
Phone (503) 215-4050

9555 SW Barnes Rd
Ste 255
Portland, OR 97225
Phone (503) 296-7800

1321 NE 99th Ave
Ste 200
Portland, OR 97220
Phone (503) 215-4250

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 and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601856000000",
    "number": "1104841543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1321 NE 99TH AVE",
            "address_2": "SUITE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972209436",
            "telephone_number": "503-215-4250",
            "fax_number": "503-215-4255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIELDS",
        "first_name": "KIMBERLY",
        "middle_name": "A",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-13",
        "last_updated": "2020-10-05",
        "certification_date": "2020-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "DO25452",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "023123",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kshields117807@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1321 NE 99th Ave",
            "address_2": "suite 200",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972209436",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.