Individual provider Active NPI

Keaton Nasser, M.D.

  • Interventional Cardiology Physician
  • Clackamas, OR
National Provider Identifier
1720433683
Registry record updated Jun 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
MD219269 Issued in OR
Practice address
10100 SE Sunnyside Rd
Clackamas, OR 97015-8970
Phone
(650) 678-5282
NPI assigned
Apr 28, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Cardiology Physician 207RI0011X 69957 AZ
Interventional Cardiology Physician 207RI0011X MD219269 OR Primary

Addresses

Primary practice location

10100 SE Sunnyside Rd
Clackamas, OR 97015-8970

Mailing address

10100 SE Sunnyside Rd
Clackamas, OR 97015-8970

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240902000117 OR Practitioner - Interventional Cardiology 7810287588 Reassigns benefits to 1 organization
I20240912002754 WA Practitioner - Interventional Cardiology 7810287588 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional Cardiology
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kaiser Foundation Health Plan of the NorthwestGroup PAC ID 5799688230, 1,805 clinicians

Practice addresses (Care Compare)

10100 SE Sunnyside Rd
Clackamas, OR 97015-8970
Phone (800) 813-2000

14406 NE 20TH Ave
Vancouver, WA 98686-1448
Phone (800) 813-2000

Hospital & facility affiliations

  • Kaiser Sunnyside Medical Center Hospital, Clackamas, OR, CCN 380091
  • Kaiser Foundation Hospital Westside Hospital, Hillsboro, OR, CCN 380103

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting1-10
Pacemaker insertion or repair1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
69957AZMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Aug 19, 2024 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Internal Medicine CurrentSince Aug 19, 2024 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Internal Medicine CurrentSince Aug 19, 2024 Accepting new patients
Kaiser Foundation Hospitals Past Accepting new patients
Unlv Medicine Internal Medicine Past Accepting new patients

Locations

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

500 NE Multnomah St
Ste 100
Portland, OR 97232
Phone (503) 499-5200

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801

7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000

14406 NE 20th Ave
Vancouver, WA 98686
Phone (360) 418-6001

Organizations & group practices 5

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 2

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": "1461801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719014400000",
    "number": "1720433683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10100 SE SUNNYSIDE RD",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970158970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10100 SE SUNNYSIDE RD",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970158970",
            "telephone_number": "650-678-5282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NASSER",
        "first_name": "KEATON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-28",
        "last_updated": "2024-06-22",
        "certification_date": "2024-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "AZ",
            "license": "69957",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "OR",
            "license": "MD219269",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10100 SE Sunnyside Rd",
            "city": "Clackamas",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970158970",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Clackamas, OR

Sources for this page

Verify at the official NPI Registry.