Kim Michelle Kelly, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

47017 Issued in MN

Practice address

12710 SE Division Street
Portland, OR 97236

Phone

(503) 988-3601

NPI assigned

Jul 25, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Family Practice

Education

University of Cincinnati College of Medicine, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

County of Clackamas Office of County AuditorGroup PAC ID 9537065560, 75 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventist Health Home Care Services Home health agency, Portland, OR, CCN 387047
• Legacy Mount Hood Medical Center Hospital, Gresham, OR, CCN 380025
• Adventist Health Portland Hospital, Portland, OR, CCN 380060
• Providence Willamette Falls Medical Center Hospital, Oregon City, OR, CCN 380038

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kkelly214489@direct.ochin.org

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.

• Clackamas County

  dba DSB Behavioral Health

  • Federally Qualified Health Center (FQHC)
  • Oregon City, OR
  • NPI 1841443587
  Medicare reassignment Care Compare group NPD
• Multnomah County

  dba Multnomah County Health Dept, North Portland

  • Federally Qualified Health Center (FQHC)
  • Portland, OR
  • NPI 1609914787
  Medicare reassignment NPD
• County of Clackamas Office of County Auditor

  dba Hilltop Behavioral Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Milwaukie, OR
  • NPI 1245269315
  NPD
• Multnomah County

  dba STD Pivot

  • State or Local Public Health Clinic/Center
  • Portland, OR
  • NPI 1417357443
  NPD
• Multnomah County

  • Federally Qualified Health Center (FQHC)
  • Gresham, OR
  • NPI 1912322074
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Legacy Mount Hood Medical Center

  • General Acute Care Hospital
  • Gresham, OR
  • NPI 1255354700
  Care Compare affiliation
• Portland Adventist Medical Center

  dba Adventist Health Portland

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1801887658
  Care Compare affiliation
• Providence Health & Services - Oregon

  dba Providence Medical Group

  • Clinic/Center
  • Portland, OR
  • NPI 1326272741

  Hospital

  Care Compare affiliation
• Providence Health & Services - Oregon

  dba Providence Willamette Falls Medical Center

  • General Acute Care Hospital
  • Oregon City, OR
  • NPI 1912282369
  Care Compare affiliation
• Western Health Resources

  dba Adventist Health Home Care Services

  • Home Health Agency
  • Portland, OR
  • NPI 1629475868
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1578585501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 SW OAK ST.",
            "address_2": "#210",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97204",
            "telephone_number": "503-988-3663",
            "fax_number": "503-988-4098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12710 SE DIVISION STREET",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97236",
            "telephone_number": "503-988-3601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KIM",
        "middle_name": "MICHELLE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-25",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "47017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jill Kelly
• Julie Anna Kelly
• Karen Gaye Kelly
• Kate Kelly, LMT
• Kathy J Kelly
• Kristen Marie Kelly, ND
• Lori H Kelly, PA-C
• Lyric A Kelly
• Matia Kelly, LPC
• Maureen Elizabeth Kelly, P.T.

• Family Medicine Physician in Portland, OR
• Providers in Portland, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.

Verify at the official NPI Registry.