Katherine Roose, CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

201608030NP-PP Issued in OR

Practice address

8645 SE Sunnybrook Blvd Ste 200
Clackamas, OR 97015-6841

Phone

(503) 659-1694

NPI assigned

Sep 29, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Katherine Zackin Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Aug 9, 2021 through Aug 9, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Pediatric Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kzackin165652@direct.lhs.org

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.

• Oregon Pediatrics-Oregon City, PC

  • Pediatrics Physician
  • Oregon City, OR
  • NPI 1114558368
  NPD (past)
• Rupa K. Shah, MD, PC

  • Pediatrics Physician
  • Clackamas, OR
  • NPI 1275579906
  NPD (past)

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

{
    "created_epoch": "1475107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587600000000",
    "number": "1821547985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8645 SE SUNNYBROOK BLVD STE 200",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970156841",
            "telephone_number": "503-659-1694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8645 SE SUNNYBROOK BLVD STE 200",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970156841",
            "telephone_number": "503-659-1694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROOSE",
        "first_name": "KATHERINE",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-29",
        "last_updated": "2020-04-23",
        "certification_date": "2020-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "OR",
            "license": "201608030NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHERINE",
            "last_name": "ZACKIN",
            "credential": "CPNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Danny Romero, LMT
• Maribel Romero
• Jon Rompel, CRNA
• David Rong
• James Rood, D.O.
• Daniel C. Root, M.D.
• Shea O'Donnell Root, M.A.
• Rose City Dialysis, LLC
• Rose City Pain Relief LLC
• Barbara Sue Rose, LPC

• Pediatric Nurse Practitioner in Clackamas, OR
• Providers in Clackamas, OR by specialty
• Pediatric Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.