Individual provider Active NPI

Kevin G Semonsen, MD

  • Diagnostic Radiology Physician
  • Portland, OR
National Provider Identifier
1629010087
Registry record updated Nov 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MD16798 Issued in OR
Practice address
1015 NW 22ND Ave
Ste T240
Portland, OR 97210-3025
Phone
(503) 413-7127
Fax
(503) 227-0218
NPI assigned
Jun 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X MD16798 OR Primary

Addresses

Primary practice location

1015 NW 22ND Ave
Ste T240
Portland, OR 97210-3025

Mailing address

PO Box 3730
#Dinw103
Portland, OR 97208-3730
Phone (800) 878-6698

Other identifiers 1

IdentifierTypeStateIssuer
081484MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD16798ORMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Meridian Park Hospital Past Accepting new patients
Open Advanced MRI Portland II, LLC Diagnostic Radiology Past Accepting new patients
Radiology Consultants, Inc Diagnostic Radiology PastSince Dec 12, 2021 Accepting new patients
TS Radiology Billings, LLC Diagnostic Radiology PastSince Dec 12, 2021 Accepting new patients
Legacy Mount Hood Medical Center Past Accepting new patients

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321401600000",
    "number": "1629010087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3730",
            "address_2": "#DINW103",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083730",
            "telephone_number": "800-878-6698",
            "fax_number": "918-665-4180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 NW 22ND AVE",
            "address_2": "STE T240",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972103025",
            "telephone_number": "503-413-7127",
            "fax_number": "503-227-0218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEMONSEN",
        "first_name": "KEVIN",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-11",
        "last_updated": "2011-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OR",
            "license": "MD16798",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "081484",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.