Kimberly Ann Kyllo-Martin, FNP-PP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

202105804NP-PP Issued in OR

Practice address

1900 Woodland Dr
Coos Bay, OR 97420-2099

Phone

(541) 267-5151

NPI assigned

Jun 21, 2021

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Bend Medical Center IncGroup PAC ID 5597677716, 92 clinicians

Coquille Valley HealthGroup PAC ID 2567902182, 20 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Oregon Coast Home Health Home health agency, Coos Bay, OR, CCN 387039
• Bay Area Hospital Hospital, Coos Bay, OR, CCN 380090
• Southern Coos Hospital & Health Center Hospital, Bandon, OR, CCN 381304

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kimberly.kyllomartin.p2@direct.coquilletribe.nextgenshare.com

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.

• Coquille Valley Health

  • Orthopaedic Surgery Physician
  • Coos Bay, OR
  • NPI 1376374967
  Medicare reassignment Care Compare group NPD
• North Bend Medical Center Inc

  • Multi-Specialty Clinic/Center
  • Coos Bay, OR
  • NPI 1407812365
  Medicare reassignment Care Compare group NPD
• Coquille Valley Health

  • Critical Access Hospital
  • Coquille, OR
  • NPI 1932080199
  NPD
• North Bend Medical Center Inc

  • Diagnostic Radiology Physician
  • Coos Bay, OR
  • NPI 1063428308
  NPD
• Coquille Valley Health

  • Family Medicine Physician
  • Myrtle Point, OR
  • NPI 1306623657
  NPD (past)

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

• Bay Area Home Health Operations LLC

  • Home Health Agency
  • Coos Bay, OR
  • NPI 1134801806
  Care Compare affiliation
• Bay Area Hospital District

  • General Acute Care Hospital
  • Coos Bay, OR
  • NPI 1225016561
  Care Compare affiliation
• Southern Coos Health District

  • Critical Access Hospital
  • Bandon, OR
  • NPI 1588684484
  Care Compare affiliation

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

{
    "created_epoch": "1624233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624406400000",
    "number": "1649849142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 WOODLAND DR",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202099",
            "telephone_number": "541-267-5151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 WOODLAND DR",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202099",
            "telephone_number": "541-267-5151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KYLLO-MARTIN",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "credential": "FNP-PP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-21",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OR",
            "license": "202105804NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Paul Kowall, M.D.
• Stephen P. Krajcir, MSW, LCSW
• Carrie Ann Kralicek, PMHNP-BC
• Teri Sue Kruzner, RN
• Leo Kusuda, M.D.
• Benjamin A La Mar, LCSW
• Jerry William Lacy
• Philip Carey Lagesse, MD
• Natasha Lamar
• Tina Lamar

• Nurse Practitioner in Coos Bay, OR
• Providers in Coos Bay, OR by specialty
• Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; 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.