Imelda C Kelly, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD23862 Issued in OR

Practice address

1350 NE 122ND Ave Ste 200
Portland, OR 97230-2011

Phone

(503) 408-7008

Fax

(503) 408-7045

NPI assigned

Apr 19, 2006

Last updated

Mar 5, 2025By the provider in NPPES

Sex

Female

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 1

Other names 1

• Imelda Eloriaga Calubaquib Other name

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

Family Practice

Education

Other, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Portland Adventist Medical CenterGroup PAC ID 3274908819, 273 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventist Health Portland Hospital, Portland, OR, CCN 380060

Merit-based Incentive Payment System (MIPS)

Final score

92 of 100Reported as group

Quality

84.7

Promoting interoperability

100

Improvement activities

40

Cost

79.21

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ikelly154554@direct.ohsu.edu

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.

• Portland Adventist Medical Center

  dba Adventist Health Medical Group

  • Family Medicine Physician
  • Portland, OR
  • NPI 1750091021
  Medicare reassignment Care Compare group NPD
• Portland Adventist Medical Center

  dba Adventist Health Portland

  • Family Medicine Physician
  • Portland, OR
  • NPI 1215910302
  Medicare reassignment NPD
• Portland Adventist Medical Center

  dba Adventist Health Portland

  • Emergency Medical Services (Emergency Medicine) Physician
  • Portland, OR
  • NPI 1316502719
  NPD
• Portland Adventist Medical Center

  dba Adventist Health Medical Group

  • Anesthesiology Physician
  • Portland, OR
  • NPI 1437925310
  NPD

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

• Portland Adventist Medical Center

  dba Adventist Health Portland

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1801887658
  Care Compare affiliation

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741132800000",
    "number": "1356306575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 NE 122ND AVE STE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972302011",
            "telephone_number": "503-408-7008",
            "fax_number": "503-408-7045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 NE 122ND AVE STE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972302011",
            "telephone_number": "503-408-7008",
            "fax_number": "503-408-7045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "IMELDA",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-19",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD23862",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "286671",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IMELDA",
            "last_name": "CALUBAQUIB",
            "middle_name": "ELORIAGA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Colleen M Kelly, LPC
• David Allen Kelly Jr., CRNP
• Eleanor Kelly
• Emily Ann Kelly, MSW
• Gabrielle Ann Kelly, MD
• Janice J Kelly, ANP
• Jennifer Elisabet Kelly, PSY.D.
• Jennifer Lynn Kelly, MA
• Jill Kelly
• Julie Anna Kelly

• Family Medicine Physician in Portland, OR
• Providers in Portland, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2025; 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.