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Individual provider Active NPI

Kimberlie Anne Dame, AGPCNP

  • Gerontology Nurse Practitioner
  • Portland, OR
National Provider Identifier
1366134843
Registry record updated Nov 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
10008811 Issued in OR
Practice address
9135 SW Barnes Rd Ste 261
Portland, OR 97225-6784
Phone
(503) 216-6300
NPI assigned
May 23, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 10008811 OR
Gerontology Nurse Practitioner 363LG0600X 10008811 OR Primary

Addresses

Primary practice location

9135 SW Barnes Rd Ste 261
Portland, OR 97225-6784

Mailing address

PO Box 3158
Portland, OR 97208-3158
Phone (503) 215-6494

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230825000809 OR Practitioner - Nurse Practitioner 9931562873 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1000 N Providence Dr
Suite 310
Newberg, OR 97132-7582
Phone (503) 537-6040

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10008811ORMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Oregon CurrentSince Aug 27, 2023 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services Oregon CurrentSince Aug 27, 2023 Accepting new patients
Providence Health & Services - Oregon CurrentSince Aug 27, 2023 Accepting new patients
Providence Health & Services - Oregon Current Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services Oregon CurrentSince Aug 27, 2023 Accepting new patients
Providence Health & Services Oregon CurrentSince Aug 27, 2023 Accepting new patients
Providence Health & Services Oregon CurrentSince Aug 27, 2023 Accepting new patients
Providence Health & Services Oregon CurrentSince Aug 27, 2023 Accepting new patients
Providence Health & Services Oregon CurrentSince Aug 27, 2023 Accepting new patients
Providence Health & Services - Oregon CurrentSince Aug 27, 2023 Accepting new patients

Locations

810 12th St
Hood River, OR 97031
Phone (541) 386-3911

1000 N Providence Dr
Ste 310
Newberg, OR 97132
Phone (503) 537-6040

1003 N Providence Dr
Ste 325
Newberg, OR 97132
Phone (503) 216-1661

4805 NE Glisan St
Ste 3E14
Portland, OR 97213

9135 SW Barnes Rd
Ste 261
Portland, OR 97225
Phone (503) 215-8650

9205 SW Barnes Rd
Portland, OR 97225
Phone (503) 216-1234

1321 NE 99th Ave
Ste 200
Portland, OR 97220
Phone (503) 215-4250

4805 NE Glisan St
Portland, OR 97213
Phone (503) 215-1111

10330 SE 32nd Ave
Ste 205
Portland, OR 97222
Phone (503) 513-8950

725 S Wahanna Rd
Seaside, OR 97138
Phone (503) 717-7000

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 5

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": "1684800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1366134843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "503-215-6494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9135 SW BARNES RD STE 261",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256784",
            "telephone_number": "503-216-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAME",
        "first_name": "KIMBERLIE",
        "middle_name": "ANNE",
        "credential": "AGPCNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-23",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OR",
            "license": "10008811",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "OR",
            "license": "10008811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.