Kelly William Rydlund, MD

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

MD25603 Issued in OR

Practice address

1508 Division St
Suite 115
Oregon City, OR 97045-1582

Phone

(503) 656-0601

Fax

(503) 656-1389

NPI assigned

Apr 20, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Otolaryngology

Education

University of Nebraska College of Medicine, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Oregon Clinic, PCGroup PAC ID 2860390408, 353 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Willamette Falls Medical Center Hospital, Oregon City, OR, CCN 380038
• Legacy Meridian Park Medical Center Hospital, Tualatin, OR, CCN 380089

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/16359/brand/1/csg/1/fhir/r4
• Direct secure messaging: cc_otoc_ent_south_front_desk_pool12223131@oc.providencedirect.org
• Direct secure messaging: krydlund134204@oc.providencedirect.org

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.

• The Oregon Clinic PC

  • Specialist
  • Portland, OR
  • NPI 1265417174
  Medicare reassignment Care Compare group NPD
• The Oregon Clinic, PC

  • Durable Medical Equipment & Medical Supplies
  • Portland, OR
  • NPI 1346105129
  NPD
• Allergy, Asthma & Immunology Associates P.C.

  • Allergy & Immunology Physician
  • Omaha, NE
  • NPI 1063471860
  NPD (past)
• ENT Physicians of Kearney, P.C.

  • Otolaryngology Physician
  • Kearney, NE
  • NPI 1992795629
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Legacy Meridian Park Hospital

  • General Acute Care Hospital
  • Tualatin, OR
  • NPI 1184647620
  Care Compare affiliation
• Providence Health & Services - Oregon

  • Clinic/Center
  • Portland, OR
  • NPI 1326272741

  Hospital

  Care Compare affiliation
• Providence Health & Services - Oregon

  • General Acute Care Hospital
  • Oregon City, OR
  • NPI 1912282369
  Care Compare affiliation

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

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730937600000",
    "number": "1306802269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 NE 20TH AVE STE 225",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322895",
            "telephone_number": "503-963-2801",
            "fax_number": "503-963-2825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1508 DIVISION ST",
            "address_2": "SUITE 115",
            "city": "OREGON CITY",
            "state": "OR",
            "postal_code": "970451582",
            "telephone_number": "503-656-0601",
            "fax_number": "503-656-1389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYDLUND",
        "first_name": "KELLY",
        "middle_name": "WILLIAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-20",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "OR",
            "license": "MD25603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2038805",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "023154",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cc_otoc_ent_south_front_desk_pool12223131@oc.providencedirect.org",
            "affiliation": "Y",
            "affiliationName": "The Oregon Clinic PC",
            "address_1": "1508 Division St",
            "address_2": "Suite 115",
            "city": "Oregon City",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970451582",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ron Rushlight
• Robert Ruel Russell, DMD, MD
• Marianne Russo
• Jerry David Ryan, LPC.CRC.NCC,MS
• Marcella Ryan
• Matthew Sablay
• Safeway Inc
• Mara Sagmiller, NP
• Irini Mekheil Sahuon, DMD
• Donald Dewitt Saint Just, MD

• Otolaryngology Physician in Oregon City, OR
• Providers in Oregon City, OR by specialty
• Otolaryngology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2024; 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.