Individual provider Active NPI

Maria Kay Kulla

  • Family Nurse Practitioner
  • Gresham, OR
National Provider Identifier
1346924446
Registry record updated Jun 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0008589 Issued in OR
Practice address
24900 SE Stark St
Gresham, OR 97030-3355
Phone
(503) 413-7162
Fax
(503) 674-4140
NPI assigned
Jun 9, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 9, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0008589 OR Primary

Addresses

Primary practice location

24900 SE Stark St
Gresham, OR 97030-3355

Mailing address

44995 SE Paha Loop Dr
Sandy, OR 97055-9424
Phone (503) 929-7971

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
I20230622001650 OR Practitioner - Nurse Practitioner 8527426659 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Clinics LLCGroup PAC ID 0244144004, 714 clinicians

Practice addresses (Care Compare)

24988 SE Stark St
Suite 220
Gresham, OR 97030-8324
Phone (503) 667-1122

Hospital & facility affiliations

  • Legacy Mount Hood Medical Center Hospital, Gresham, OR, CCN 380025

Merit-based Incentive Payment System (MIPS)

Final score
94.62 of 100Reported as apm
Quality
77.21
Promoting interoperability
99.06
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0008589ORMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Clinics LLC CurrentSince Jun 13, 2023 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince Mar 20, 2025 Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Mar 20, 2025 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince Mar 20, 2025 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center Current Accepting new patients
Legacy Clinics LLC CurrentSince Jun 13, 2023 Accepting new patients
Legacy Emanuel Hospital & Health Center Current Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Mar 20, 2025 Accepting new patients
Legacy Mount Hood Medical Center PastSince Jun 11, 2023 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center Past Accepting new patients

Locations

1960 NW 167th Pl
Ste 205
Beaverton, OR 97006
Phone (503) 629-7500

24988 SE Stark St
Ste 220
Gresham, OR 97030
Phone (503) 674-1580

24900 SE Stark St
Ste 109
Gresham, OR 97030
Phone (503) 667-1015

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

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

1130 NW 22nd Ave
Ste 400
Portland, OR 97210
Phone (503) 413-6555

1919 NW Lovejoy St
Portland, OR 97209
Phone (503) 415-5600

1200 NW 23rd Ave
Portland, OR 97210
Phone (503) 413-7074

1040 NW 22nd Ave
Ste 630
Portland, OR 97210
Phone (503) 796-2743

1040 NW 22nd Ave
Ste 660
Portland, OR 97210
Phone (503) 692-0405

501 N Graham St
Ste 200
Portland, OR 97227
Phone (503) 413-4488

19250 SW 65th Ave
Tualatin, OR 97062
Phone (503) 691-6582

Organizations & group practices 10

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1686268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686268800000",
    "number": "1346924446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44995 SE PAHA LOOP DR",
            "city": "SANDY",
            "state": "OR",
            "postal_code": "970559424",
            "telephone_number": "503-929-7971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24900 SE STARK ST",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970303355",
            "telephone_number": "503-413-7162",
            "fax_number": "503-674-4140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KULLA",
        "first_name": "MARIA",
        "middle_name": "KAY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-06-09",
        "last_updated": "2023-06-09",
        "certification_date": "2023-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "0008589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gresham, OR

Sources for this page

Verify at the official NPI Registry.