Individual provider Active NPI

Kelly Ma, MD, MPH

  • Ophthalmology Physician
  • Portland, OR
National Provider Identifier
1346535267
Registry record updated May 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
MD171281 Issued in OR
Practice address
1040 NW 22ND Ave
Portland, OR 97210-3057
Phone
(503) 413-8498
NPI assigned
Jun 20, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X MD171281 OR Primary

Addresses

Primary practice location

1040 NW 22ND Ave
Portland, OR 97210-3057

Mailing address

85 E Concord St FL 8
Dept of Ophthalmology
Boston, MA 02118-2335
Phone (617) 414-4020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20150522001339 OR Practitioner - Ophthalmology 8820220742 Reassigns benefits to 1 organization
I20161014001185 WA Practitioner - Ophthalmology 8820220742 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Tufts University School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kaiser Foundation Health Plan of the NorthwestGroup PAC ID 5799688230, 1,805 clinicians

Practice addresses (Care Compare)

10100 SE Sunnyside Rd
Clackamas, OR 97015-8970
Phone (800) 813-2000

10180 SE Sunnyside Rd
Clackamas, OR 97015-8970
Phone (800) 813-2000

12100 SE Stevens CT
Suite 106
Portland, OR 97086-4707
Phone (800) 813-2000

3600 N Interstate Ave
Portland, OR 97227-1106
Phone (800) 813-2000

3620 N Interstate Ave
Portland, OR 97227-1106
Phone (800) 813-2000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest Ophthalmology CurrentSince Sep 19, 2016 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Sep 19, 2016 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Ophthalmology CurrentSince Sep 19, 2016 Accepting new patients

Locations

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

7201 N Interstate Ave
Portland, OR 97217
Phone (503) 240-4051

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801

7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1308528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431043200000",
    "number": "1346535267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 E CONCORD ST FL 8",
            "address_2": "DEPT OF OPHTHALMOLOGY",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182335",
            "telephone_number": "617-414-4020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 NW 22ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972103057",
            "telephone_number": "503-413-8498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MA",
        "first_name": "KELLY",
        "name_prefix": "Dr.",
        "credential": "MD, MPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-20",
        "last_updated": "2015-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "OR",
            "license": "MD171281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.