Individual provider Active NPI

Kelly Ann Fair, M.D.

  • Surgery Physician
  • Salem, OR
National Provider Identifier
1144547415
Registry record updated Apr 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
MD176652 Issued in OR
Practice address
890 Oak St SE
Salem, OR 97301-3905
Phone
(503) 561-2448
NPI assigned
Apr 27, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Critical Care Physician 2086S0102X MD176652 OR
Surgery Physician 208600000X MD176652 OR Primary

Addresses

Primary practice location

890 Oak St SE
Salem, OR 97301-3905

Mailing address

PO Box 14001
Salem, OR 97309-5014

Other practice location 1

300 N Graham St Ste 125
Portland, OR 97227-1683
Phone (503) 413-3714

Other practice location 2

2200 NE Neff Rd Ste 302
Bend, OR 97701-4279
Phone (541) 706-6915

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kfair207191@secure.stcharleshealthcare.org

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171107002265 OR Practitioner - Critical Care (Intensivists)Practitioner - General Surgery 3173768918 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: General Surgery
Education
University of Colorado School of Medicine, Denver, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Clinics LLCGroup PAC ID 0244144004, 714 clinicians

Practice addresses (Care Compare)

300 N Graham St
Suite 125
Portland, OR 97227-1683
Phone (503) 413-3714

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair (minimally invasive)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD176652ORMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Salem Health CurrentSince Oct 2, 2017 Accepting new patients
St. Charles Health System, Inc. CurrentSince Nov 12, 2024 Accepting new patients
Legacy Clinics LLC CurrentSince Dec 3, 2024 Accepting new patients
St. Charles Health System, Inc. CurrentSince Nov 12, 2024 Accepting new patients
Legacy Clinics LLC CurrentSince Dec 3, 2024 Accepting new patients
Salem Health CurrentSince Oct 2, 2017 Accepting new patients
St. Charles Health System, Inc. Past Accepting new patients
Legacy Emanuel Hospital & Health Center Past Accepting new patients
St. Charles Health System, Inc. Past Accepting new patients

Locations

29358 Network Pl
Chicago, IL 60673

2500 NE Neff Rd
Bend, OR 97701
Phone (541) 388-4333

2200 NE Neff Rd
Ste 302
Bend, OR 97701
Phone (541) 706-4220

2200 NE Neff Rd
Bend, OR 97701
Phone (541) 322-2323

300 N Graham St
Ste 125
Portland, OR 97227
Phone (503) 413-3714

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

211 NW Larch Ave
Redmond, OR 97756
Phone (541) 548-2164

665 Winter St SE
Salem, OR 97301
Phone (503) 370-5634

890 Oak St SE
Salem, OR 97301
Phone (503) 585-0830

Interoperability endpoints

  • Direct secure messaging: kfair178637@direct.salemhealth.org

Organizations & group practices 9

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 4

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": "1272326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745971200000",
    "number": "1144547415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14001",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973095014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "890 OAK ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013905",
            "telephone_number": "503-561-2448"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 N Graham St Ste 125",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972271683",
            "country_code": "US",
            "telephone_number": "503-413-3714",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2200 NE Neff Rd Ste 302",
            "address_purpose": "LOCATION",
            "city": "Bend",
            "state": "OR",
            "postal_code": "977014279",
            "country_code": "US",
            "telephone_number": "541-706-6915",
            "fax_number": "541-706-6733",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAIR",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-27",
        "last_updated": "2025-04-30",
        "certification_date": "2025-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "OR",
            "license": "MD176652",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OR",
            "license": "MD176652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kfair207191@secure.stcharleshealthcare.org",
            "affiliation": "N",
            "address_1": "2200 NE Neff Rd Ste 302",
            "city": "Bend",
            "state": "OR",
            "country_code": "US",
            "postal_code": "977014279",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

Verify at the official NPI Registry.