Active NPI
Kelly Mahara Bartholomew, PA-C
- Surgical Physician Assistant
- Portland, OR
National Provider Identifier
1255328290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- Practice address
- 2226 NW Pettygrove
Portland, OR 97210 - Phone
- (503) 223-6223
- Fax
- (503) 223-3665
- NPI assigned
- Oct 4, 2005
- Last updated
- May 1, 2015
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | OR | Primary |
Addresses
Primary practice location
2226 NW Pettygrove
Portland, OR 97210
Mailing address
2230 NW Pettygrove
#210
Portland, OR 97210
Phone (503) 223-6223
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA00693 | Medicaid | OR |
Other names 1
- Kelly Mahara Charles
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 693 | OR | MD | Naturopath |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Oregon Clinic, PC | Past | Accepting new patients | |
| Northwest Urological Clinic PC | Past | Accepting new patients |
Interoperability endpoints
- kelly.bartholomew.1@11085.direct.athenahealth.com
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Specialist
- Portland, OR
- NPI 1619995172
-
- Durable Medical Equipment & Medical Supplies
- Portland, OR
- NPI 1346105129
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1430438400000",
"number": "1255328290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2230 NW PETTYGROVE",
"address_2": "#210",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97210",
"telephone_number": "503-223-6223",
"fax_number": "503-223-3665"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2226 NW PETTYGROVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97210",
"telephone_number": "503-223-6223",
"fax_number": "503-223-3665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BARTHOLOMEW",
"first_name": "KELLY",
"middle_name": "MAHARA",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-04",
"last_updated": "2015-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "OR",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PA00693",
"state": "OR"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KELLY",
"last_name": "CHARLES",
"middle_name": "MAHARA",
"code": "1",
"type": "Former Name"
}
]
}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 May 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.