Kevin Michael Reavis, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

MD24248 Issued in OR

Practice address

4805 NE Glisan St Ste 6N60
Portland, OR 97213-2933

Phone

(503) 935-8379

Fax

(503) 935-8940

NPI assigned

May 20, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Electronic endpoints 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General Surgery

Education

Vanderbilt University School of Medicine, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Providence Health and Services OregonGroup PAC ID 0648183608, 1,423 clinicians

The Oregon Clinic, PCGroup PAC ID 2860390408, 353 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Portland Medical Center Hospital, Portland, OR, CCN 380061
• Columbia Memorial Hospital Hospital, Astoria, OR, CCN 381320
• Legacy Good Samaritan Medical Center Hospital, Portland, OR, CCN 380017
• Legacy Meridian Park Medical Center Hospital, Tualatin, OR, CCN 380089
• Providence St Vincent Medical Center Hospital, Portland, OR, CCN 380004

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kreavis133601@oc.providencedirect.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.

• Providence Health & Services Oregon

  • General Practice Physician
  • Lake Oswego, OR
  • NPI 1023488343
  Medicare reassignment Care Compare group NPD
• The Oregon Clinic PC

  • Specialist
  • Portland, OR
  • NPI 1265417174
  Medicare reassignment Care Compare group NPD
• Providence Health & Services - Oregon

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1003991845
  Medicare reassignment NPD
• Providence Health & Services - Oregon

  • Family Medicine Physician
  • Gresham, OR
  • NPI 1053419218
  NPD
• Providence Health & Services - Oregon

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1073604955
  NPD
• Providence Health & Services - Oregon

  • Clinical Pathology Physician
  • Portland, OR
  • NPI 1740732650
  NPD
• Providence Health & Services Oregon

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Portland, OR
  • NPI 1396818993
  NPD
• Providence Health & Services Oregon

  • Psychiatry Physician
  • Portland, OR
  • NPI 1760177737
  NPD
• The Oregon Clinic, PC

  • Durable Medical Equipment & Medical Supplies
  • Portland, OR
  • NPI 1346105129
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Columbia Lutheran Charities

  • Critical Access Hospital
  • Astoria, OR
  • NPI 1134146939
  Care Compare affiliation
• Columbia Lutheran Charities

  • Cardiovascular Disease Physician
  • Astoria, OR
  • NPI 1629378880

  Hospital

  Care Compare affiliation
• Columbia Lutheran Charities

  • Critical Access Hospital
  • Astoria, OR
  • NPI 1700809761
  Care Compare affiliation
• Columbia Lutheran Charities

  • Surgery Physician
  • Astoria, OR
  • NPI 1821254129

  Hospital

  Care Compare affiliation
• Columbia Lutheran Charities

  • Surgery Physician
  • Astoria, OR
  • NPI 1871747659

  Hospital

  Care Compare affiliation
• Legacy Good Samaritan Hospital and Medical Center

  • Clinic/Center
  • Portland, OR
  • NPI 1679597108

  Hospital

  Care Compare affiliation
• Legacy Good Samaritan Hospital and Medical Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1780608216
  Care Compare affiliation
• Legacy Meridian Park Hospital

  • General Acute Care Hospital
  • Tualatin, OR
  • NPI 1184647620
  Care Compare affiliation
• Providence Health & Services - Oregon

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1003991845
  Care Compare affiliation
• Providence Health & Services - Oregon

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1114015971
  Care Compare affiliation
• Providence Health & Services - Oregon

  • Case Manager/Care Coordinator
  • Portland, OR
  • NPI 1891822995

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758153600000",
    "number": "1891749149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 NE 20TH AVE STE 225",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322895",
            "telephone_number": "503-963-2801",
            "fax_number": "503-963-2825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4805 NE GLISAN ST STE 6N60",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132933",
            "telephone_number": "503-935-8379",
            "fax_number": "503-935-8940"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9155 SW Barnes Rd Ste 735",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972256634",
            "country_code": "US",
            "telephone_number": "503-935-8379",
            "fax_number": "503-935-8940",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REAVIS",
        "first_name": "KEVIN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-20",
        "last_updated": "2025-09-18",
        "certification_date": "2025-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "35087725",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OR",
            "license": "MD24248",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2676297",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1891749149",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "227282",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cc_otoc_cas_front_desk_pool12223192@or.providencedirect.org",
            "affiliation": "Y",
            "affiliationName": "The Oregon Clinic PC",
            "address_1": "4805 NE Glisan St",
            "address_2": "Suite 6N60",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972132933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Seth C Reasor, LMSW, CSWA.
• Alyson Reaves
• Dina Reavis
• James Earl Reavis, LCSW
• Katherine Reavis
• Caroline Reay, MD
• Rebecca Changizian
• Rebecca Kuperstein, DDS, MPH, Ms, PC
• Rebecca Oyer, MSW, LCSW, Sep, LLC
• Rebel Heart Therapy LLC

• Surgery Physician in Portland, OR
• Providers in Portland, OR by specialty
• Surgery Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.