Individual provider Active NPI

Christina E Kellogg-Gratchner, P.N.P.

  • Pediatric Nurse Practitioner
  • Hillsboro, OR
National Provider Identifier
1124015631
Registry record updated Apr 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
086000482 Issued in OR
Practice address
445 E Main St
Hillsboro, OR 97123-4084
Phone
(503) 640-2757
Fax
(503) 640-9753
NPI assigned
Sep 29, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 086000482 OR Primary

Addresses

Primary practice location

445 E Main St
Hillsboro, OR 97123-4084

Mailing address

445 E Main St
Hillsboro, OR 97123-4084
Phone (503) 640-2757

Other identifiers 2

IdentifierTypeStateIssuer
R167202OtherPTAN
000458MedicaidOR

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
I20121205000089 OR Practitioner - Nurse Practitioner 5395997951 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
086000482ORMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Hillsboro Pediatric Clinic LLC CurrentSince Aug 31, 2012 Accepting new patients

Locations

6125 NE Cornell Rd
Ste 240
Hillsboro, OR 97124
Phone (503) 640-2757

445 E Main St
Hillsboro, OR 97123
Phone (503) 640-2757

445 E Main St
Ste 100
Hillsboro, OR 97123
Phone (503) 640-3147

Interoperability endpoints

  • Direct secure messaging: cgratchner@hpc.ssdirect.aprima.com

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365638400000",
    "number": "1124015631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 E MAIN ST",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971234084",
            "telephone_number": "503-640-2757",
            "fax_number": "503-640-9753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 E MAIN ST",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971234084",
            "telephone_number": "503-640-2757",
            "fax_number": "503-640-9753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLOGG-GRATCHNER",
        "first_name": "CHRISTINA",
        "middle_name": "E",
        "credential": "P.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-29",
        "last_updated": "2013-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "OR",
            "license": "086000482",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "R167202",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000458",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hillsboro, OR

Sources for this page

Verify at the official NPI Registry.