Individual provider Active NPI

Kristin Shandel Martin, NP

  • Family Nurse Practitioner
  • Portland, OR
National Provider Identifier
1639983133
Registry record updated Apr 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
10035209 Issued in OR
Practice address
15640 NW Laidlaw Rd Ste 102
Portland, OR 97229-3828
Phone
(503) 956-7120
NPI assigned
Feb 4, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 10035209 OR Primary

Addresses

Primary practice location

15640 NW Laidlaw Rd Ste 102
Portland, OR 97229-3828

Mailing address

PO Box 3158
Portland, OR 97208-3158

Other names 1

  • Kristin Shandel Perry Former name

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250325001124 OR Practitioner - Nurse Practitioner 9032632666 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

15640 NW Laidlaw Rd
Suite 102
Portland, OR 97229-3828
Phone (503) 764-0100

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Oregon CurrentSince Apr 20, 2025 Accepting new patients
Providence Health & Services Oregon CurrentSince Apr 20, 2025 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services - Oregon Past Accepting new patients

Locations

10330 SE 32nd Ave
Ste 205
Portland, OR 97222
Phone (503) 513-8950

15640 NW Laidlaw Rd
Ste 102
Portland, OR 97229
Phone (503) 764-0100

1321 NE 99th Ave
Ste 200
Portland, OR 97220
Phone (503) 215-4250

18040 SW Lower Boones Ferry Rd
Ste 304
Tigard, OR 97224
Phone (503) 216-0700

Organizations & group practices 4

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 1

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": "1738627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743465600000",
    "number": "1639983133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15640 NW LAIDLAW RD STE 102",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972293828",
            "telephone_number": "503-956-7120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "KRISTIN",
        "middle_name": "SHANDEL",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-02-04",
        "last_updated": "2025-04-01",
        "certification_date": "2025-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "10035209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTIN",
            "last_name": "PERRY",
            "middle_name": "SHANDEL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.