NPIMap

Individual provider Active NPI

Kathryn Marie Shine, FNP

  • Family Nurse Practitioner
  • Redmond, OR
National Provider Identifier
1720522873
Registry record updated Jun 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
201607532NP-PP Issued in OR
Practice address
1541 NW Canal Blvd
Redmond, OR 97756-1341
Phone
(541) 706-5800
Fax
(541) 706-5800
NPI assigned
Dec 8, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 201607532NP-PP OR Primary

Addresses

Primary practice location

1541 NW Canal Blvd
Redmond, OR 97756-1341

Mailing address

2800 SW 257TH Ave
Troutdale, OR 97060-1803
Phone (503) 667-7711

Other practice location 1

2800 SW 257th Ave
Troutdale, OR 97060-1803
Phone (503) 667-7711

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kshine151726@secure.stcharleshealthcare.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
I20170510000753 OR Practitioner - Nurse Practitioner 1759662505 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Charles Health System IncGroup PAC ID 8729111513, 379 clinicians

Practice addresses (Care Compare)

1541 NW Canal Blvd
Cancer Cent
Redmond, OR 97756-1341
Phone (541) 706-5800

211 NW Larch Ave
Family Care
Redmond, OR 97756-1357
Phone (541) 548-2164

2500 NE Neff Rd
Bend, OR 97701-6015

61250 SE Coombs PL
Family Care Clin
Bend, OR 97702-3704
Phone (541) 706-5935

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St. Charles Health System, Inc. CurrentSince May 30, 2022 Accepting new patients
St. Charles Health System, Inc. CurrentSince May 30, 2022 Accepting new patients
St. Charles Health System, Inc. Past Accepting new patients

Locations

29358 Network Pl
Chicago, IL 60673

2300 NE Neff Rd
Bend, OR 97701
Phone (541) 330-9001

2500 NE Neff Rd
Bend, OR 97701
Phone (541) 388-4333

211 NW Larch Ave
Redmond, OR 97756
Phone (541) 548-2164

1541 NW Canal Blvd
Redmond, OR 97756
Phone (541) 322-3500

Interoperability endpoints

  • Direct secure messaging: kshine151726@secure.stcharleshealthcare.org

Organizations & group practices 3

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 9

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": "1481155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655078400000",
    "number": "1720522873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 SW 257TH AVE",
            "city": "TROUTDALE",
            "state": "OR",
            "postal_code": "970601803",
            "telephone_number": "503-667-7711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1541 NW CANAL BLVD",
            "city": "REDMOND",
            "state": "OR",
            "postal_code": "977561341",
            "telephone_number": "541-706-5800",
            "fax_number": "541-706-5800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2800 SW 257th Ave",
            "address_purpose": "LOCATION",
            "city": "Troutdale",
            "state": "OR",
            "postal_code": "970601803",
            "country_code": "US",
            "telephone_number": "503-667-7711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHINE",
        "first_name": "KATHRYN",
        "middle_name": "MARIE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-08",
        "last_updated": "2022-06-13",
        "certification_date": "2022-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "201607532NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kshine151726@secure.stcharleshealthcare.org",
            "affiliation": "N",
            "address_1": "1541 NW Canal Blvd",
            "city": "Redmond",
            "state": "OR",
            "country_code": "US",
            "postal_code": "977561341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Redmond, OR

Sources for this page

Verify at the official NPI Registry.