Active NPI
Kimberly Hillis
- Physical Medicine & Rehabilitation Physician
- Portland, OR
National Provider Identifier
1720311996
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- 4100
- Practice address
- 300 N Graham St
Suite 430
Portland, OR 97227-1683 - Phone
- (503) 413-3013
- Fax
- (503) 413-1501
- NPI assigned
- Sep 4, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 4100 | OR | Primary |
Addresses
Primary practice location
300 N Graham St
Suite 430
Portland, OR 97227-1683
Mailing address
300 N Graham St
Suite 430
Portland, OR 97227-1683
Phone (503) 413-3013
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4100 | Other | OR | PHYSICAL THEAPY LISCENSING BOARD OF OREGON |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4100 | OR | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1252022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1291593600000",
"number": "1720311996",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 N GRAHAM ST",
"address_2": "SUITE 430",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972271683",
"telephone_number": "503-413-3013",
"fax_number": "503-413-1501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 N GRAHAM ST",
"address_2": "SUITE 430",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972271683",
"telephone_number": "503-413-3013",
"fax_number": "503-413-1501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HILLIS",
"first_name": "KIMBERLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-09-04",
"last_updated": "2010-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "OR",
"license": "4100",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICAL THEAPY LISCENSING BOARD OF OREGON",
"identifier": "4100",
"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 Dec 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.