NPIMap

Organization Active NPI

Kevin Driscoll DPM, LLC

  • Foot & Ankle Surgery Podiatrist
  • Portland, OR
National Provider Identifier
1326625856
Registry record updated Jun 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
KEVIN DRISCOLL DPM, LLC
Practice address
6108 NE Glisan St
Portland, OR 97213-3864
Phone
(503) 255-8100
Fax
(503) 255-2728
NPI assigned
Mar 29, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2024

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

Authorized official

Name
Dr. Kevin Driscoll, DPMNPI 1699272724
Title
Physician
Phone
(503) 255-8100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X
Primary Podiatric Medicine PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213EP1101X
Foot & Ankle Surgery PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213ES0103X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Surgical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AS0400X

Addresses

Primary practice location

6108 NE Glisan St
Portland, OR 97213-3864

Mailing address

6108 NE Glisan St
Portland, OR 97213-3864
Phone (503) 255-8100

Other names 1

  • Oregon Foot Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20210602002288 OR Part B Supplier - Clinic/Group Practice 7719386226 Receives reassigned benefits from 4 practitioners
Practice locations: Portland, OR
O20210818003775 OR DME Supplier - Physician - Podiatry 7719386226 Practice locations: Portland, OR

National Provider Directory

National Provider Directory

Locations

6108 NE Glisan St
Portland, OR 97213
Phone (503) 255-8100

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1616976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718755200000",
    "number": "1326625856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6108 NE GLISAN ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972133864",
            "telephone_number": "503-255-8100",
            "fax_number": "503-255-2728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6108 NE GLISAN ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972133864",
            "telephone_number": "503-255-8100",
            "fax_number": "503-255-2728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVIN DRISCOLL DPM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-29",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-19",
        "status": "A",
        "authorized_official_last_name": "DRISCOLL",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "503-255-8100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213EP1101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oregon Foot Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.