Kelly Marie King, P.A.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

LL17410 Issued in OR

Practice address

13013 SW Caddy PL
Tigard, OR 97223-2892

Phone

(503) 766-3263

NPI assigned

Oct 9, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

Specialty

Physician Assistant

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Peacehealth Networks on Demand LLCGroup PAC ID 1759731383, 197 clinicians

Columbia Medical Clinic PCGroup PAC ID 7012917842, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kelly.king.2@30646.direct.athenahealth.com
• Direct secure messaging: kelly.king.1@11271.direct.athenahealth.com

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.

• Peacehealth Networks on Demand, LLC

  • General Practice Physician
  • Tigard, OR
  • NPI 1023582178
  Medicare reassignment Care Compare group NPD
• Columbia Medical Clinic PC

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1184785842
  Medicare reassignment Care Compare group
• Columbia Pharmacy LLC

  • Community/Retail Pharmacy
  • Portland, OR
  • NPI 1104121938
  NPD (past)

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

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602633600000",
    "number": "1235327883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13013 SW CADDY PL",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972232892",
            "telephone_number": "503-766-3263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13013 SW CADDY PL",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972232892",
            "telephone_number": "503-766-3263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "P.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-09",
        "last_updated": "2020-10-14",
        "certification_date": "2020-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "LL17410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kking535623@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "18040 SW Lower Boones Ferry Rd Ste 100",
            "city": "Tigard",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972247259",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Hyoshin Kim, ND
• Rie Kimura-Opperman, D.M.D.
• King City Rehab, LLC
• Foster A King, DPT
• Gates T King
• Sonya M King, LMT
• Terrence King
• Tia Kinilau
• Maryse Kintz
• Kate Bernadette Kipers

• Medical Physician Assistant in Tigard, OR
• Providers in Tigard, OR by specialty
• Medical Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2020; 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.

Verify at the official NPI Registry.