Individual provider Active NPI

Kyle Pearson, M.D.

  • Student in an Organized Health Care Education/Training Program
  • Salem, OR
National Provider Identifier
1376961771
Registry record updated Apr 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
890 Oak St SE
Salem, OR 97301-3905
Phone
(503) 631-5400
NPI assigned
Apr 2, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 25, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 167864 OR
Student in an Organized Health Care Education/Training Program 390200000X OR Primary

Addresses

Primary practice location

890 Oak St SE
Salem, OR 97301-3905

Mailing address

Room B5314
Salem Hospital Adult Medicine Hospitalist
Salem, OR 97309
Phone (503) 631-5400

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171113002147 OR Practitioner - Internal Medicine 0547565293 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2013
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)

2400 Lancaster Dr NE
Salem, OR 97305-1221
Phone (800) 813-2000

890 Oak St SE
Salem, OR 97301-3905
Phone (800) 813-2000

Hospital & facility affiliations

  • Salem Hospital Hospital, Salem, OR, CCN 380051

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
167864ORMDGeneral Acute Care Hospital

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Aug 28, 2017 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Aug 28, 2017 Accepting new patients

Locations

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

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

890 Oak St SE
Salem, OR 97301
Phone (503) 585-0830

Organizations & group practices 2

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": "1396396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493078400000",
    "number": "1376961771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ROOM B5314",
            "address_2": "SALEM HOSPITAL ADULT MEDICINE HOSPITALIST",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "97309",
            "telephone_number": "503-631-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "890 OAK ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013905",
            "telephone_number": "503-631-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEARSON",
        "first_name": "KYLE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-04-02",
        "last_updated": "2017-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "OR",
            "license": "167864",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

Verify at the official NPI Registry.