Active NPI
Kerry Councilman, MD
- Anatomic Pathology & Clinical Pathology Physician
- Bend, OR
National Provider Identifier
1497904452
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 48166
- Practice address
- 1348 NE Cushing Dr
Bend, OR 97701-3876 - Phone
- (541) 382-7696
- NPI assigned
- Sep 15, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 48166 | OR | Primary |
Addresses
Primary practice location
1348 NE Cushing Dr
Bend, OR 97701-3876
Mailing address
1348 NE Cushing Dr
Bend, OR 97701-3876
Phone (541) 382-7696
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20824713 | Medicaid | CO |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220420000177 | OR | Practitioner - Pathology | 8123210937 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Pathology
- Education
- Texas Tech University Health Science Center School of Medicine, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Central Oregon Pathology Consultants PC
Practice addresses (Care Compare)
1348 NE Cushing Dr
Bend, OR 97701-3876
Hospital & facility affiliations
- St Charles Medical Center - Bend
- Harney District Hospital
- Lake District Hospital
- St Charles Madras
Merit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 48166 | OR | MD | Anatomic Pathology & Clinical Pathology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central Oregon Pathology Consultants, PC | Anatomic Pathology & Clinical Pathology | Current | Accepting new patients |
Locations
1348 NE Cushing Dr
Ste 200
Bend, OR 97701
Phone (541) 382-7696
1348 NE Cushing Dr
Ste 20
Bend, OR 97701
1348 NE Cushing Dr
Bend, OR 97701
Phone (541) 382-7696
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 and National Provider Directory roles.
-
- Anatomic Pathology & Clinical Pathology Physician
- Bend, OR
- NPI 1124140926
Anatomic Pathology & Clinical Pathology, OR
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Sleep Disorder Diagnostic Clinic/Center
- Bend, OR
- NPI 1164675963
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1221436800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1772496000000",
"number": "1497904452",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1348 NE CUSHING DR",
"city": "BEND",
"state": "OR",
"postal_code": "977013876",
"telephone_number": "541-382-7696"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1348 NE CUSHING DR",
"city": "BEND",
"state": "OR",
"postal_code": "977013876",
"telephone_number": "541-382-7696"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COUNCILMAN",
"first_name": "KERRY",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-09-15",
"last_updated": "2026-03-03",
"certification_date": "2026-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "OR",
"license": "48166",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "20824713",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.