Kellie L Graybosch, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA156616 Issued in OR

Practice address

9427 SW Barnes Rd
Ste 495
Portland, OR 97225-6652

Phone

(503) 216-1661

NPI assigned

Oct 6, 2011

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

Other identifiers 2

Electronic endpoints 1

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

Physician Assistant

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Providence Health and Services OregonGroup PAC ID 0648183608, 1,423 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence St Vincent Medical Center Hospital, Portland, OR, CCN 380004
• Providence Portland Medical Center Hospital, Portland, OR, CCN 380061

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Providence Health & Services Oregon

  dba Providence Medical Group

  • General Practice Physician
  • Lake Oswego, OR
  • NPI 1023488343
  Medicare reassignment Care Compare group
• Providence Health & Services - Oregon

  dba Providence Medical Group

  • Medical Oncology Physician
  • Portland, OR
  • NPI 1255740965
  NPD
• Providence Health & Services Oregon

  dba Providence Medical Group

  • Psychiatry Physician
  • Portland, OR
  • NPI 1760177737
  NPD

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

• Providence Health & Services - Oregon

  dba Providence Portland Medical Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1003991845
  Care Compare affiliation
• Providence Health & Services - Oregon

  dba Providence St Vincent Medical Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1114015971
  Care Compare affiliation
• Providence Health & Services - Oregon

  • Case Manager/Care Coordinator
  • Portland, OR
  • NPI 1891822995

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1317859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615334400000",
    "number": "1720362882",
    "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": "9427 SW BARNES RD",
            "address_2": "STE 495",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256652",
            "telephone_number": "503-216-1661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAYBOSCH",
        "first_name": "KELLIE",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-06",
        "last_updated": "2021-03-10",
        "certification_date": "2021-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA156616",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500640073",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE (PH&S)",
            "identifier": "P01046628",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kgraybosch107955@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "9427 SW Barnes Rd",
            "address_2": "Ste 495",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972256652",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sorrell Jolene Gray
• Susan D. Gray, D.C.
• Sydney Margaret Gray, RN
• Jane Elizabeth Graybill
• Robert Allen Graybill, ND
• Hannah Erin Grayson
• Salena Shantel Grayson
• Richard Grazer, MD
• Alyssa Joelle Graziano
• Jeremy Graziano, O.D.

• Physician Assistant in Portland, OR
• Providers in Portland, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 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.