Individual provider Active NPI

Matthew Paul Keeslar, PA-C

  • Medical Physician Assistant
  • Portland, OR
National Provider Identifier
1295283380
Registry record updated Nov 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA188921 Issued in OR
Practice address
6924 NE Sandy Blvd
Portland, OR 97213-5256
Phone
(503) 300-4111
Fax
(503) 954-2122
NPI assigned
Sep 16, 2016
Last updated
Nov 14, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA188921 OR Primary

Addresses

Primary practice location

6924 NE Sandy Blvd
Portland, OR 97213-5256

Mailing address

6924 NE Sandy Blvd
Portland, OR 97213-5256
Phone (503) 300-4111

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
I20181115000451 OR Practitioner - Physician Assistant 4284988932 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Oregon Sleep and Pulmonary LLCGroup PAC ID 5092893222, 6 clinicians

Practice addresses (Care Compare)

2228 NW Pettygrove St
Suite 150
Portland, OR 97210-2761
Phone (503) 288-5201

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Crest Childrens Urgent Care LLC CurrentSince Nov 19, 2023 Accepting new patients
Orthopedic & Sports Medicine Center of Or LLC Past Accepting new patients

Locations

6924 NE Sandy Blvd
Portland, OR 97213
Phone (503) 300-4111

Interoperability endpoints

  • Direct secure messaging: matthew.keeslar.1@20484.direct.athenahealth.com

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1473984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699920000000",
    "number": "1295283380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6924 NE SANDY BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972135256",
            "telephone_number": "503-300-4111",
            "fax_number": "503-954-2122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6924 NE SANDY BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972135256",
            "telephone_number": "503-300-4111",
            "fax_number": "503-954-2122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEESLAR",
        "first_name": "MATTHEW",
        "middle_name": "PAUL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-09-16",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA188921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.