Active NPI
Brian Wilbur Kelly, MD
- Internal Medicine Physician
- Hillsboro, OR
National Provider Identifier
1801990478
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD10756
- Practice address
- 545 SE Oak St
Suite F
Hillsboro, OR 97123-4147 - Phone
- (503) 640-5950
- Fax
- (503) 648-3140
- NPI assigned
- Sep 12, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD10756 | OR | Primary |
| Pulmonary Disease Physician | 207RP1001X | MD10756 | OR |
Addresses
Primary practice location
545 SE Oak St
Suite F
Hillsboro, OR 97123-4147
Mailing address
545 SE Oak St
Suite F
Hillsboro, OR 97123-4147
Phone (503) 640-5950
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 227538 | Medicaid | OR | |
| C9123100001 | Other | OR | PROVIDENCE |
| DG4207 | Other | OR | RAILROAD MEDICARE GROUP # |
| 003293001 | Other | OR | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD10756 | OR | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421193600000",
"number": "1801990478",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "545 SE OAK ST",
"address_2": "SUITE F",
"city": "HILLSBORO",
"state": "OR",
"postal_code": "971234147",
"telephone_number": "503-640-5950",
"fax_number": "503-648-3140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "545 SE OAK ST",
"address_2": "SUITE F",
"city": "HILLSBORO",
"state": "OR",
"postal_code": "971234147",
"telephone_number": "503-640-5950",
"fax_number": "503-648-3140"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "BRIAN",
"middle_name": "WILBUR",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-12",
"last_updated": "2015-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "OR",
"license": "MD10756",
"primary": true
},
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "OR",
"license": "MD10756",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "227538",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PROVIDENCE",
"identifier": "C9123100001",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE GROUP #",
"identifier": "DG4207",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "003293001",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hillsboro, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.