Individual provider Active NPI

Kenneth M Leclerc, M.D.

  • Cardiovascular Disease Physician
  • Tualatin, OR
National Provider Identifier
1760483754
Registry record updated Feb 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
MD172293 Issued in OR
Practice address
19250 SW 65TH Ave, Suite 265
Tualatin, OR 97062
Phone
(503) 413-7162
Fax
(503) 692-2101
NPI assigned
Aug 2, 2005
Last updated
Feb 1, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X L4038 TX
Cardiovascular Disease Physician 207RC0000X MD172293 OR Primary

Addresses

Primary practice location

19250 SW 65TH Ave, Suite 265
Tualatin, OR 97062

Mailing address

PO Box 3777
Portland, OR 97208-3777
Phone (503) 413-3900

Other identifiers 1

IdentifierTypeStateIssuer
500685619MedicaidOR

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
I20150615002057 OR Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 6507836814 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
University of Oklahoma College of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Legacy Clinics LLCGroup PAC ID 0244144004, 714 clinicians
Legacy Meridian Park HospitalGroup PAC ID 5092609842, 113 clinicians

Practice addresses (Care Compare)

1015 NW 22ND Ave
Portland, OR 97210-3025
Phone (503) 413-7711

1015 Nw22Nd Ave
Suite 34
Portland, OR 97210-3025
Phone (503) 413-6376

1040 NW 22ND Ave
Suite 630
Portland, OR 97210-3041
Phone (503) 413-7162

1130 NW 22ND Ave
Suite 220
Portland, OR 97210-2969
Phone (503) 413-8988

19250 SW 65TH Ave
Suite 265
Tualatin, OR 97062-7747
Phone (503) 413-6862

19300 SW 65TH Ave
Tualatin, OR 97062-7706
Phone (503) 692-2500

2801 N Gantenbein Ave
Portland, OR 97227-1623
Phone (503) 413-1122

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.62 of 100Reported as apm
Quality
77.21
Promoting interoperability
99.06
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
92.83 of 100Reported as group
Quality
96.26
Promoting interoperability
100
Improvement activities
40
Cost
79.84

Merit-based Incentive Payment System (MIPS)

Final score
92.34 of 100Reported as group
Quality
92.55
Promoting interoperability
100
Improvement activities
40
Cost
76.53

Merit-based Incentive Payment System (MIPS)

Final score
94.62 of 100Reported as apm
Quality
77.21
Promoting interoperability
99.06
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
94.62 of 100Reported as apm
Quality
77.21
Promoting interoperability
99.06
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
94.62 of 100Reported as apm
Quality
77.21
Promoting interoperability
99.06
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
77.82 of 100Reported as group
Quality
64.68
Promoting interoperability
100
Improvement activities
40
Cost
47.05

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD172293ORMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Emanuel Hospital & Health Center CurrentSince Sep 28, 2015 Accepting new patients
Legacy Meridian Park Hospital CurrentSince Sep 28, 2015 Accepting new patients
Legacy Mount Hood Medical Center CurrentSince Oct 1, 2019 Accepting new patients
Silverton Health CurrentSince Apr 14, 2018 Accepting new patients
Legacy Mount Hood Medical Center CurrentSince Oct 1, 2019 Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Sep 28, 2015 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince Sep 28, 2015 Accepting new patients
Silverton Health Current Accepting new patients
Legacy Good Samaritan Hospital and Medical Center Current Accepting new patients
Legacy Clinics LLC CurrentSince Jul 1, 2015 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince Sep 28, 2015 Accepting new patients
Legacy Emanuel Hospital & Health Center Current Accepting new patients
Silverton Health CurrentSince Apr 14, 2018 Accepting new patients
Legacy Clinics LLC CurrentSince Jul 1, 2015 Accepting new patients
Legacy Meridian Park Hospital Past Accepting new patients
South Texas Cardiovascular Consultants Cardiovascular Disease Past Accepting new patients
San Antonio Cardiology Clinic PA Cardiovascular Disease Past Accepting new patients
Legacy Good Samaritan Hospital and Medical Center Past Accepting new patients
Methodist Physician Practices, PLLC Cardiovascular Disease Past 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

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

1040 NW 22nd Ave
Ste 630
Portland, OR 97210
Phone (503) 796-2743

1040 NW 22nd Ave
Ste 660
Portland, OR 97210
Phone (503) 692-0405

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

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

1200 NW 23rd Ave
Portland, OR 97210
Phone (503) 413-7074

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

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

342 Fairview St
Silverton, OR 97381
Phone (503) 525-7660

19250 SW 65th Ave
Tualatin, OR 97062
Phone (503) 691-6582

19250 SW 65th Ave
Ste 265
Tualatin, OR 97062
Phone (503) 692-3110

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

2211 NE 139th St
Vancouver, WA 98686
Phone (360) 397-1985

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/16700/brand/2/csg/1/fhir/r4
  • Direct secure messaging: kleclerc115062@direct.lhs.org

Organizations & group practices 19

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.

View all 19

Hospital & facility affiliations 8

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": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485907200000",
    "number": "1760483754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3777",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083777",
            "telephone_number": "503-413-3900",
            "fax_number": "503-413-3710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19250 SW 65TH AVE, SUITE 265",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "97062",
            "telephone_number": "503-413-7162",
            "fax_number": "503-692-2101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LECLERC",
        "first_name": "KENNETH",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-02",
        "last_updated": "2017-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TX",
            "license": "L4038",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OR",
            "license": "MD172293",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500685619",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tualatin, OR

Sources for this page

Verify at the official NPI Registry.