Individual provider Active NPI

Kelsey Selene Peterson Wolfe, M.D.

  • Emergency Medicine Physician
  • Portland, OR
National Provider Identifier
1386175396
Registry record updated Aug 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
197994 Issued in OR
Practice address
25 NW 23Rd PL
Portland, OR 97210-5580
Phone
(503) 305-6262
NPI assigned
Mar 22, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 197994 OR Primary

Addresses

Primary practice location

25 NW 23Rd PL
Portland, OR 97210-5580

Mailing address

25 NW 23Rd PL
Portland, OR 97210-5580

Other practice location 1

1611 NW 12th Ave
Miami, FL 33136-1005
Phone (503) 473-6148

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20210726001097 WA Practitioner - Emergency Medicine 8729403167 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergency Medicine Associates PCGroup PAC ID 3870526858, 37 clinicians

Practice addresses (Care Compare)

600 NE 92ND Ave
Vancouver, WA 98664-3225
Phone (360) 514-2142

Hospital & facility affiliations

  • Peacehealth Southwest Medical Cente Hospital, Vancouver, WA, CCN 500050

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
197994ORMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medicine Associates PC Emergency Medicine CurrentSince Aug 1, 2021 Accepting new patients
Uptown Providers Inc PastSince Jul 15, 2020 Accepting new patients
Uptown Providers PC PastSince Jul 15, 2020 Accepting new patients
Peacehealth PastSince Aug 1, 2021 Accepting new patients

Locations

600 NE 92nd Ave
Vancouver, WA 98664
Phone (360) 514-2142

Organizations & group practices 4

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 2

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": "1490140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596585600000",
    "number": "1386175396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 NW 23RD PL",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972105580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 NW 23RD PL",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972105580",
            "telephone_number": "503-305-6262"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1611 NW 12th Ave",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "FL",
            "postal_code": "331361005",
            "country_code": "US",
            "telephone_number": "503-473-6148",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WOLFE",
        "first_name": "KELSEY",
        "middle_name": "SELENE PETERSON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-22",
        "last_updated": "2020-08-05",
        "certification_date": "2020-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OR",
            "license": "197994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.