Individual provider Active NPI

Kiva Stevens

  • Physician Assistant
  • Klamath Falls, OR
National Provider Identifier
1801480850
Registry record updated Nov 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
209492 Issued in OR
Practice address
2821 Daggett Ave Ste 100
Klamath Falls, OR 97601-1130
Phone
(541) 274-6733
NPI assigned
Feb 21, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 209492 OR Primary

Addresses

Primary practice location

2821 Daggett Ave Ste 100
Klamath Falls, OR 97601-1130

Mailing address

2821 Daggett Ave Ste 100
Klamath Falls, OR 97601-1130
Phone (541) 274-6733

Other practice location 1

2730 S Moody Ave
Portland, OR 97201-5042
Phone (503) 494-3633

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
I20221207000508 OR Practitioner - Physician Assistant 9739558149 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sky Lakes Medical Center IncGroup PAC ID 1052204096, 196 clinicians

Practice addresses (Care Compare)

2801 Daggett Ave
Klamath Falls, OR 97601-7150
Phone (541) 274-6221

2821 Daggett Ave
Suite 100
Klamath Falls, OR 97601-1106
Phone (541) 274-6733

2865 Daggett Ave
Klamath Falls, OR 97601-1106
Phone (541) 274-6221

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209492ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sky Lakes Medical Center Inc CurrentSince Nov 21, 2022 Accepting new patients
Sky Lakes Medical Center Inc Past Accepting new patients

Locations

2821 Daggett Ave
Ste 100
Klamath Falls, OR 97601
Phone (541) 274-4611

2865 Daggett Ave
Klamath Falls, OR 97601
Phone (541) 833-6221

Interoperability endpoints

  • Direct secure messaging: kstevens@yourcarecommunity.org

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1613865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668729600000",
    "number": "1801480850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2821 DAGGETT AVE STE 100",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976011130",
            "telephone_number": "541-274-6733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2821 DAGGETT AVE STE 100",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976011130",
            "telephone_number": "541-274-6733"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2730 S Moody Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972015042",
            "country_code": "US",
            "telephone_number": "503-494-3633",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STEVENS",
        "first_name": "KIVA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-21",
        "last_updated": "2022-11-18",
        "certification_date": "2022-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "209492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Klamath Falls, OR

Sources for this page

Verify at the official NPI Registry.