Individual provider Active NPI

Kimberly Ann Suriano, MD

  • Obstetrics & Gynecology Physician
  • Portland, OR
National Provider Identifier
1508960964
Registry record updated Nov 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
MD23925 Issued in OR
Practice address
501 N Graham St Ste 550
Portland, OR 97227-2010
Phone
(503) 284-5220
Fax
(503) 284-4971
NPI assigned
Sep 7, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X MD23925 OR Primary

Addresses

Primary practice location

501 N Graham St Ste 550
Portland, OR 97227-2010

Mailing address

541 NE 20TH Ave Ste 225
Portland, OR 97232-2895
Phone (503) 963-2801

Other identifiers 2

IdentifierTypeStateIssuer
286395MedicaidOR
1012173MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cc_otoc_obgyn_north_front_desk_pool12223217@oc.providencedirect.org The Oregon Clinic PC

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
I20050405000150 OR Practitioner - Obstetrics/Gynecology 3779530506 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of California, Irvine, California College of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Oregon Clinic, PCGroup PAC ID 2860390408, 353 clinicians

Practice addresses (Care Compare)

1111 NE 99TH Ave
Portland, OR 97220-9442

501 N Graham St
Suite 550
Portland, OR 97227-2010
Phone (503) 284-5220

5050 NE Hoyt
Suite 655
Portland, OR 97213-2990
Phone (503) 239-6673

Hospital & facility affiliations

  • Legacy Good Samaritan Medical Center Hospital, Portland, OR, CCN 380017
  • Legacy Emanuel Medical Center Hospital, Portland, OR, CCN 380007
  • Providence Portland Medical Center Hospital, Portland, OR, CCN 380061

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD23925ORMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Oregon Clinic PC Obstetrics & Gynecology CurrentSince Jul 1, 2014 Accepting new patients
The Oregon Clinic, PC CurrentSince Jul 1, 2014 Accepting new patients

Locations

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

501 N Graham St
Ste 445
Portland, OR 97227
Phone (503) 284-5220

541 NE 20th Ave
Ste 225
Portland, OR 97232
Phone (503) 963-2801

5050 NE Hoyt St
Ste 655
Portland, OR 97213
Phone (503) 239-6673

501 N Graham St
Ste 550
Portland, OR 97227
Phone (503) 284-5220

847 NE 19th Ave
Ste 300
Portland, OR 97232

Interoperability endpoints

  • Direct secure messaging: ksuriano133666@oc.providencedirect.org
  • Direct secure messaging: ksuriano154840@direct.ohsu.edu

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 8

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": "1157587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731283200000",
    "number": "1508960964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 NE 20TH AVE STE 225",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322895",
            "telephone_number": "503-963-2801",
            "fax_number": "503-963-2825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 N GRAHAM ST STE 550",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972272010",
            "telephone_number": "503-284-5220",
            "fax_number": "503-284-4971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SURIANO",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-07",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OR",
            "license": "MD23925",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "286395",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1012173",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cc_otoc_obgyn_north_front_desk_pool12223217@oc.providencedirect.org",
            "affiliation": "Y",
            "affiliationName": "The Oregon Clinic PC",
            "address_1": "501 N Graham St Ste 550",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972272010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.