Individual provider Active NPI

John Mark Kinzie, MD

  • Psychiatry Physician
  • Portland, OR
National Provider Identifier
1386652840
Registry record updated Jul 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MD24995 Issued in OR
Practice address
3181 SW Sam Jackson Park Rd
Uhn 80
Portland, OR 97239-3011
Phone
(503) 494-8617
NPI assigned
Aug 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X MD24995 OR Primary

Addresses

Primary practice location

3181 SW Sam Jackson Park Rd
Uhn 80
Portland, OR 97239-3011

Mailing address

3181 SW Sam Jackson Park Rd
Ohsu/ Uhn 80T
Portland, OR 97239-3011
Phone (503) 418-1608

Other identifiers 1

IdentifierTypeStateIssuer
022453MedicaidOR

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
I20040610000176 OR Practitioner - Psychiatry 0345223434 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Oregon Health Sciences University School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University Professional ServicesGroup PAC ID 4880760107, 1,683 clinicians

Practice addresses (Care Compare)

15700 SW Greystone CT
Beaverton, OR 97006-6011
Phone (503) 494-3442

2525 SW 1St Ave
Portland, OR 97201-4753

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone (503) 494-8311

Hospital & facility affiliations

  • Ohsu Hospital and Clinics Hospital, Portland, OR, CCN 380009

Merit-based Incentive Payment System (MIPS)

Final score
99.11 of 100Reported as apm
Quality
84.29
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University Professional Services Current Accepting new patients
Oregon Health & Science University CurrentSince Jul 20, 2009 Accepting new patients
University Professional Services CurrentSince Jan 1, 2009 Accepting new patients
University Professional Services CurrentSince Jan 1, 2009 Accepting new patients
Oregon Health & Science University CurrentSince Jul 20, 2009 Accepting new patients
Legacy Emanuel Hospital & Health Center Current Accepting new patients
Legacy Emanuel Hospital & Health Center Psychiatry CurrentSince Feb 26, 2017 Accepting new patients
Oregon Health & Science University Current Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Feb 26, 2017 Accepting new patients

Locations

15700 SW Greystone Ct
Beaverton, OR 97006
Phone (503) 203-1000

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

3181 SW Sam Jackson Park Rd
#80
Portland, OR 97239
Phone (503) 494-8144

3181 SW Sam Jackson Park Rd
Portland, OR 97239
Phone (503) 494-5674

6327 SE Milwaukie Ave
Portland, OR 97202
Phone (503) 418-8236

15220 NW Laidlaw Rd
Ste 100
Portland, OR 97229
Phone (503) 418-2000

1225 NE 2nd Ave
Portland, OR 97232
Phone (503) 413-5051

3181 SW Sam Jackson Park Rd
#80T
Portland, OR 97239

Interoperability endpoints

  • Direct secure messaging: jkinzie12535@direct.ohsu.edu

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": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184284800000",
    "number": "1386652840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD",
            "address_2": "OHSU/ UHN 80T",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393011",
            "telephone_number": "503-418-1608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD",
            "address_2": "UHN 80",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393011",
            "telephone_number": "503-494-8617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINZIE",
        "first_name": "JOHN",
        "middle_name": "MARK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-03",
        "last_updated": "2007-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OR",
            "license": "MD24995",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022453",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.