Matthew Ewing Kelm

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

THW000108871 Issued in OR

Practice address

1942 Sheridan Ave
North Bend, OR 97459-3416

Phone

(458) 895-4974

NPI assigned

May 24, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Bay Area First Step, Inc.

  • Community/Behavioral Health Agency
  • North Bend, OR
  • NPI 1871970897
  NPD (past)

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

{
    "created_epoch": "1684886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684886400000",
    "number": "1821780180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1942 SHERIDAN AVE",
            "city": "NORTH BEND",
            "state": "OR",
            "postal_code": "974593416",
            "telephone_number": "458-895-4974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1942 SHERIDAN AVE",
            "city": "NORTH BEND",
            "state": "OR",
            "postal_code": "974593416",
            "telephone_number": "458-895-4974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELM",
        "first_name": "MATTHEW",
        "middle_name": "EWING",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-24",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OR",
            "license": "THW000108871",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Kanies
• Peter Alan Karth, MD
• Teneisha C Kay, RN
• Richard Keith
• Elizabeth Kellner, DDS
• Marly Kennedy, PMHNP
• Rene P Kidinger
• Dustin W King
• Stephen Jay Kinsley, M.D.
• Jon Kintner, M.D.

• Peer Specialist in North Bend, OR
• Providers in North Bend, OR by specialty
• Peer Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.