NPIMap

Individual provider Active NPI

Kristen P Massimino, MD

  • Surgical Oncology Physician
  • Portland, OR
National Provider Identifier
1720208556
Registry record updated Mar 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Oncology PhysicianTaxonomy code 2086X0206X
License
MD171629 Issued in OR
Practice address
9155 SW Barnes Rd Ste 238
Portland, OR 97225-6629
Phone
(503) 216-6407
NPI assigned
Apr 26, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MD171629 OR
Surgical Oncology Physician 2086X0206X MD171629 OR Primary

Addresses

Primary practice location

9155 SW Barnes Rd Ste 238
Portland, OR 97225-6629

Mailing address

PO Box 3158
Portland, OR 97208-3158

Other practice location 1

3181 SW Sam Jackson Park Road #L579
Portland, OR 97239-3098
Phone (503) 494-8652

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kmassimino122837@oc.providencedirect.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150727001389 OR Practitioner - Surgical Oncology 3375788276 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Surgical Oncology
Education
Wright State University Boonshoft School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

9155 SW Barnes Rd
Suite 238
Portland, OR 97225-6629
Phone (503) 216-0246

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy61
Melanoma (skin cancer) excision1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Oregon CurrentSince Nov 1, 2017 Accepting new patients
Providence Health & Services Oregon CurrentSince Nov 1, 2017 Accepting new patients
Providence Health & Services - Oregon CurrentSince Nov 1, 2017 Accepting new patients
Providence Health & Services - Oregon CurrentSince Nov 1, 2017 Accepting new patients
Providence Health & Services Oregon CurrentSince Nov 1, 2017 Accepting new patients
Providence Health & Services - Oregon Current Accepting new patients
Providence Health & Services Oregon CurrentSince Nov 1, 2017 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients

Locations

5050 NE Hoyt St
Ste 454
Portland, OR 97213
Phone (503) 215-6405

9205 SW Barnes Rd
Portland, OR 97225
Phone (503) 216-1234

9155 SW Barnes Rd
Ste 238
Portland, OR 97225
Phone (503) 223-7214

4805 NE Glisan St
Portland, OR 97213
Phone (503) 215-1111

5050 NE Hoyt St
Ste 240
Portland, OR 97213
Phone (503) 215-6480

Organizations & group practices 8

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 4

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": "1177545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616371200000",
    "number": "1720208556",
    "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": "9155 SW BARNES RD STE 238",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256629",
            "telephone_number": "503-216-6407"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3181 SW Sam Jackson Park Road #L579",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972393098",
            "country_code": "US",
            "telephone_number": "503-494-8652",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MASSIMINO",
        "first_name": "KRISTEN",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-26",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OR",
            "license": "MD171629",
            "primary": false
        },
        {
            "code": "2086X0206X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Oncology",
            "state": "OR",
            "license": "MD171629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmassimino122837@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "9155 SW Barnes Rd Ste 238",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972256629",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.