Individual provider Active NPI

Kyran L Colbry, M.D.

  • Emergency Medicine Physician
  • Salem, OR
National Provider Identifier
1740218122
Registry record updated Dec 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD24949 Issued in OR
Practice address
665 Winter St SE
Salem, OR 97301-3919
Phone
(503) 561-5634
NPI assigned
Jun 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD24949 OR Primary

Addresses

Primary practice location

665 Winter St SE
Salem, OR 97301-3919

Mailing address

PO Box 2505
Salem, OR 97308-2505
Phone (888) 828-3198

Other identifiers 4

IdentifierTypeStateIssuer
8426181MedicaidWA
022549OtherMARION POLK CHP
8906214OtherWA L&I
022549MedicaidOR

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040714000176 OR Practitioner - Emergency Medicine 9830178938 Reassigns benefits to 3 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Salem Emergency Physicians Service, PC Emergency Medicine CurrentSince Mar 1, 2005 Accepting new patients
Salem Health West Valley CurrentSince Oct 2, 2022 Accepting new patients
Salem Health Past Accepting new patients

Locations

525 SE Washington St
Dallas, OR 97338
Phone (503) 623-7344

1601 Monmouth St
Ste 100
Independence, OR 97351
Phone (503) 623-8301

665 Winter St SE
Salem, OR 97301
Phone (503) 370-5634

890 Oak St SE
Bldg A
Salem, OR 97301
Phone (503) 370-5634

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.

NPI Registry JSON

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198022400000",
    "number": "1740218122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2505",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973082505",
            "telephone_number": "888-828-3198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "665 WINTER ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013919",
            "telephone_number": "503-561-5634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLBRY",
        "first_name": "KYRAN",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2007-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OR",
            "license": "MD24949",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8426181",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MARION POLK CHP",
            "identifier": "022549",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA L&I",
            "identifier": "8906214",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022549",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

Verify at the official NPI Registry.