Individual provider Active NPI

Kathleen M O'Brien, PA-C

  • Physician Assistant
  • N Charleston, SC
National Provider Identifier
1740623099
Registry record updated Jan 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2569 Issued in SC
Practice address
8901 University Blvd
N Charleston, SC 29406-9116
Phone
(843) 203-2245
Fax
(843) 203-2244
NPI assigned
Apr 16, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA168556 OR
Physician Assistant 363A00000X 2569 SC Primary

Addresses

Primary practice location

8901 University Blvd
N Charleston, SC 29406-9116

Mailing address

PO Box 751649
Charlotte, NC 28275-1649
Phone (843) 789-1620

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Kathleen.Obrien@rsfpp.eclinicaldirectplus.com Direct

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141201001420 OR Practitioner - Physician Assistant 5799007837 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2569SCMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince Jan 1, 2022 Accepting new patients
Northwest Acute Care Specialists PC CurrentSince Jan 31, 2022 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince Jan 1, 2022 Accepting new patients

Locations

24800 SE Stark St
Gresham, OR 97030
Phone (503) 413-8407

1015 NW 22nd Ave
Portland, OR 97210
Phone (503) 413-7582

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

1040 NW 22nd Ave
Ste 168
Portland, OR 97210
Phone (503) 413-7022

1130 NW 22nd Ave
Ste 400
Portland, OR 97210
Phone (503) 413-6555

1919 NW Lovejoy St
Portland, OR 97209
Phone (503) 415-5600

19300 SW 65th Ave
Tualatin, OR 97062
Phone (503) 692-1212

Interoperability endpoints

  • Direct secure messaging: kathleen.obrien@rsfpp.eclinicaldirectplus.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1366070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611532800000",
    "number": "1740623099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751649",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751649",
            "telephone_number": "843-789-1620",
            "fax_number": "843-724-2440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8901 UNIVERSITY BLVD",
            "city": "N CHARLESTON",
            "state": "SC",
            "postal_code": "294069116",
            "telephone_number": "843-203-2245",
            "fax_number": "843-203-2244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'BRIEN",
        "first_name": "KATHLEEN",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-16",
        "last_updated": "2021-01-25",
        "certification_date": "2021-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA168556",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "2569",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Kathleen.Obrien@rsfpp.eclinicaldirectplus.com",
            "affiliation": "N",
            "endpointDescription": "Document and CCD Exchange",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Patient Care Documents",
            "address_1": "8901 University Blvd",
            "city": "N Charleston",
            "state": "SC",
            "country_code": "US",
            "postal_code": "294069116",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in N Charleston, SC

Sources for this page

Verify at the official NPI Registry.