NPIMap

Individual provider Active NPI

Maria Green Kallman, PA

  • Medical Physician Assistant
  • Unalaska, AK
National Provider Identifier
1700268786
Registry record updated Mar 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
131031 Issued in AK
Practice address
34 Lavelle CT.
Unalaska, AK 99685
Phone
(907) 581-1202
NPI assigned
Jun 25, 2015
Last updated
Mar 16, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 16, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA.0004294 CO
Medical Physician Assistant 363AM0700X 131031 AK Primary

Addresses

Primary practice location

34 Lavelle CT.
Unalaska, AK 99685

Mailing address

34 Lavelle CT.
PO Box 144
Unalaska, AK 99685
Phone (907) 581-1202

Other practice location 1

1015 NW 22nd Ave
Portland, OR 97210-3025
Phone (503) 413-8090

Other identifiers 1

IdentifierTypeStateIssuer
1684141MedicaidAK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, WA, OR3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20150819006698 CO Practitioner - Physician Assistant 7618282708 Reassigns benefits to 1 organization
I20190226003225 WA Practitioner - Physician Assistant 7618282708 Reassigns benefits to 3 organizations
I20190814003534 OR Practitioner - Physician Assistant 7618282708 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
96.85 of 100Reported as group
Quality
84.92
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA.0004294COMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Public Hospital District No 2, Klickitat County, Washington CurrentSince Dec 1, 2018 Accepting new patients
Northwest Acute Care Specialists PC CurrentSince May 1, 2021 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince Jan 7, 2021 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince Jan 7, 2021 Accepting new patients
Public Hospital District No 2, Klickitat County Washington CurrentSince Dec 1, 2018 Accepting new patients
Peacehealth Past Accepting new patients
Iliuliuk Family &Health Services, Inc. Past Accepting new patients

Locations

1015 NW 22nd Ave
Portland, OR 97210
Phone (503) 413-7582

1040 NW 22nd Ave
Ste 168
Portland, OR 97210
Phone (503) 413-7022

1130 NW 22nd Ave
Ste 400
Portland, OR 97210
Phone (503) 413-6555

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

212 NE Skyline Dr
White Salmon, WA 98672
Phone (509) 493-2133

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/ac6e817f-dc27-43e8-b886-6559f137e853/

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1435190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615852800000",
    "number": "1700268786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 LAVELLE CT.",
            "address_2": "PO BOX 144",
            "city": "UNALASKA",
            "state": "AK",
            "postal_code": "99685",
            "telephone_number": "907-581-1202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 LAVELLE CT.",
            "city": "UNALASKA",
            "state": "AK",
            "postal_code": "99685",
            "telephone_number": "907-581-1202"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1015 NW 22nd Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972103025",
            "country_code": "US",
            "telephone_number": "503-413-8090",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KALLMAN",
        "first_name": "MARIA",
        "middle_name": "GREEN",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-25",
        "last_updated": "2021-03-16",
        "certification_date": "2021-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "PA.0004294",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AK",
            "license": "131031",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1684141",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Unalaska, AK

Sources for this page

Verify at the official NPI Registry.