Individual provider Active NPI

Kelly Sheridan Wright, MD

  • Internal Medicine Physician
  • Portland, OR
National Provider Identifier
1407083215
Registry record updated May 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD167227 Issued in OR
Practice address
8332 SE 13TH Ave
Portland, OR 97202-7102
Phone
(503) 595-9300
NPI assigned
Jun 18, 2009
Last updated
May 24, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD19283 ME
Internal Medicine Physician 207R00000X MD167227 OR Primary

Addresses

Primary practice location

8332 SE 13TH Ave
Portland, OR 97202-7102

Mailing address

PO Box 568
Cornelius, OR 97113-0568
Phone (503) 359-5564

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
I20141205001523 OR Practitioner - Internal Medicine 1951550441 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Jefferson Medical College of Thomas Jefferson University, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sellwood Medical Clinic PCGroup PAC ID 3274526868, 6 clinicians

Practice addresses (Care Compare)

8332 SE 13TH Ave
Portland, OR 97202-7102
Phone (503) 595-9300

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD167227ORMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sellwood Medical Clinic PC CurrentSince Jun 1, 2015 Accepting new patients

Locations

8332 SE 13th Ave
Portland, OR 97202
Phone (503) 595-9300

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/3083/brand/1/csg/1/fhir/r4

Organizations & group practices 1

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.

Hospital & facility affiliations 4

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": "1245283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558656000000",
    "number": "1407083215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 568",
            "city": "CORNELIUS",
            "state": "OR",
            "postal_code": "971130568",
            "telephone_number": "503-359-5564",
            "fax_number": "503-357-4371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8332 SE 13TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972027102",
            "telephone_number": "503-595-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WRIGHT",
        "first_name": "KELLY",
        "middle_name": "SHERIDAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-18",
        "last_updated": "2019-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ME",
            "license": "MD19283",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD167227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.