NPIMap

Individual provider Active NPI

Kelly Wulf, PA-C

  • Medical Physician Assistant
  • Portland, OR
National Provider Identifier
1750654323
Registry record updated Nov 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA164512 Issued in OR
Practice address
2565 NW Lovejoy St
Suite 100
Portland, OR 97210-2996
Phone
(503) 279-9700
Fax
(503) 279-8114
NPI assigned
Feb 13, 2012
Last updated
Nov 8, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X PA164512 OR
Physician Assistant 363A00000X PA164512 OR
Medical Physician Assistant 363AM0700X PA164512 OR Primary

Addresses

Primary practice location

2565 NW Lovejoy St
Suite 100
Portland, OR 97210-2996

Mailing address

8614 E Mill Plain Blvd
Ste 400
Vancouver, WA 98664-2092
Phone (360) 254-5267

Other names 1

  • Kelly O'Brien Former name

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
I20131206000061 OR Practitioner - Physician Assistant 7214164870 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clackamas Dermatology PCGroup PAC ID 4183618440, 11 clinicians

Practice addresses (Care Compare)

18345 SW Alexander St
Suite B
Beaverton, OR 97003-3960
Phone (503) 654-7546

545 SE Oak St
Hillsboro, OR 97123-4147
Phone (503) 654-7546

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.11 of 100Reported as apm
Quality
84.29
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA164512ORMDDermatology Physician

Organizations & group practices 2

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.

Hospital & facility affiliations 12

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": "1329091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541635200000",
    "number": "1750654323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8614 E MILL PLAIN BLVD",
            "address_2": "STE 400",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986642092",
            "telephone_number": "360-254-5267",
            "fax_number": "360-254-6089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2565 NW LOVEJOY ST",
            "address_2": "SUITE 100",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102996",
            "telephone_number": "503-279-9700",
            "fax_number": "503-279-8114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WULF",
        "first_name": "KELLY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-13",
        "last_updated": "2018-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OR",
            "license": "PA164512",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA164512",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA164512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "O'BRIEN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.