Individual provider Active NPI

Reza Kafi, MD

  • Dermatology Physician
  • Portland, OR
National Provider Identifier
1891737201
Registry record updated Mar 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
MD181659 Issued in OR
Practice address
417 SW 117TH Ave Ste 100
Portland, OR 97225-5924
Phone
(503) 216-8980
Fax
(503) 216-8999
NPI assigned
Jun 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X A84048 CA
Dermatology Physician 207N00000X MD181659 OR Primary

Addresses

Primary practice location

417 SW 117TH Ave Ste 100
Portland, OR 97225-5924

Mailing address

PO Box 3158
Portland, OR 97208-3158

Other practice location 1

751 S Bascom Ave
Dermatology Department
San Jose, CA 95128-2604
Phone (408) 885-5000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rkafi674238@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, OR2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20051013000596 CA Practitioner - Dermatology 6204851793 Reassigns benefits to 1 organization
I20171017000591 OR Practitioner - Dermatology 6204851793 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Michigan Medical School, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Direct Dermatology Professionals PCGroup PAC ID 1153585948, 7 clinicians

Practice addresses (Care Compare)

1321 NE 99TH Ave
Suite 200
Portland, OR 97220-9439
Phone (503) 215-4250

165 Saint Dominics Dr
Suite 120
Manteca, CA 95337-7802
Phone (855) 944-7546

417 SW 117TH Ave
Portland, OR 97225-5924

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1521
Removal or shaving of skin growth1-10
Skin biopsy294

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
84048CAMDMarriage & Family Therapist
A84048CAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Oregon CurrentSince Nov 1, 2017 Accepting new patients
Providence Health & Services Oregon CurrentSince May 1, 2023 Accepting new patients
Providence Health & Services - Oregon Dermatology CurrentSince May 1, 2023 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services - Oregon CurrentSince Nov 1, 2017 Accepting new patients
Direct Dermatology Professionals PC Dermatology CurrentSince Dec 14, 2016 Accepting new patients
County of Santa Clara Past Accepting new patients
Last Frontier Healthcare District Past Accepting new patients
Providence Health & Services - Oregon Past Accepting new patients

Locations

165 Saint Dominics Dr
Ste 120
Manteca, CA 95337
Phone (209) 823-0000

530 Lytton Ave
Fl 2
Palo Alto, CA 94301
Phone (415) 663-5584

8100 Timberlake Way
Ste F
Sacramento, CA 95823
Phone (916) 689-4889

9205 SW Barnes Rd
Ste 2800
Portland, OR 97225
Phone (503) 216-2621

5050 NE Hoyt St
Ste 240
Portland, OR 97213
Phone (503) 215-6480

1321 NE 99th Ave
Ste 200
Portland, OR 97220
Phone (503) 215-4250

9205 SW Barnes Rd
Portland, OR 97225
Phone (503) 216-1234

417 SW 117th Ave
Ste 100
Portland, OR 97225
Phone (503) 216-8980

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: rkafi674238@oc.providencedirect.org

Organizations & group practices 9

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 3

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": "1149984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616025600000",
    "number": "1891737201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 SW 117TH AVE STE 100",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255924",
            "telephone_number": "503-216-8980",
            "fax_number": "503-216-8999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "751 S Bascom Ave",
            "address_2": "Dermatology Department",
            "address_purpose": "LOCATION",
            "city": "San Jose",
            "state": "CA",
            "postal_code": "951282604",
            "country_code": "US",
            "telephone_number": "408-885-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KAFI",
        "first_name": "REZA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-11",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A84048",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OR",
            "license": "MD181659",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rkafi674238@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "417 SW 117th Ave Ste 100",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972255924",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.