Individual provider Active NPI

Karen L Kostenko, PA-C

  • Physician Assistant
  • Portland, OR
National Provider Identifier
1841672870
Registry record updated Jan 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA187236 Issued in OR
Practice address
1350 NE 122ND Ave Ste 200
Portland, OR 97230-2011
Phone
(503) 408-7008
Fax
(503) 666-6745
NPI assigned
Jun 26, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 53029 CA
Physician Assistant 363A00000X PA187236 OR Primary

Addresses

Primary practice location

1350 NE 122ND Ave Ste 200
Portland, OR 97230-2011

Mailing address

1350 NE 122ND Ave Ste 200
Portland, OR 97230-2011
Phone (503) 408-7008

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
I20200203001486 OR Practitioner - Physician Assistant 2860784360 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Portland Adventist Medical CenterGroup PAC ID 3274908819, 273 clinicians

Practice addresses (Care Compare)

10151 SE Sunnyside Rd
Suite 100
Clackamas, OR 97015-5705
Phone (503) 659-0880

17055 Ruben LN
Sandy, OR 97055-9276
Phone (503) 668-8002

Hospital & facility affiliations

  • Adventist Health Portland Hospital, Portland, OR, CCN 380060

Merit-based Incentive Payment System (MIPS)

Final score
92 of 100Reported as group
Quality
84.7
Promoting interoperability
100
Improvement activities
40
Cost
79.21

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA187236ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Portland Adventist Medical Center CurrentSince Dec 26, 2019 Accepting new patients
Portland Adventist Medical Center CurrentSince Jul 16, 2023 Accepting new patients

Locations

10151 SE Sunnyside Rd
Ste 100
Clackamas, OR 97015
Phone (503) 659-0880

14450 SE Royer Rd
Damascus, OR 97089
Phone (503) 658-5521

1350 NE 122nd Ave
Ste 200
Portland, OR 97230
Phone (503) 408-7008

Interoperability endpoints

  • Direct secure messaging: kkostenko154575@direct.ohsu.edu

Organizations & group practices 3

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 1

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": "1435276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579046400000",
    "number": "1841672870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 NE 122ND AVE STE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972302011",
            "telephone_number": "503-408-7008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 NE 122ND AVE STE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972302011",
            "telephone_number": "503-408-7008",
            "fax_number": "503-666-6745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSTENKO",
        "first_name": "KAREN",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-26",
        "last_updated": "2020-01-15",
        "certification_date": "2020-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "53029",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA187236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.