Active NPI
Kerry Ben Callahan, M.D.
- Family Medicine Physician
- Portland, OR
National Provider Identifier
1902871932
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 16630
- Practice address
- 541 NE 20TH Ave
Suite 210
Portland, OR 97232 - Phone
- (503) 233-6940
- Fax
- (503) 236-2676
- NPI assigned
- Feb 22, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 16630 | OR | Primary |
Addresses
Primary practice location
541 NE 20TH Ave
Suite 210
Portland, OR 97232
Mailing address
800 SW 13TH Ave
Portland, OR 97205-1902
Phone (503) 221-0161
Other practice location 1
5005 NE Sandy Blvd
Portland, OR 97213-1941
Phone (503) 233-6940
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8138299 | Medicaid | WA | |
| 49534 | Other | WA | WA DEPT. L&I |
| 043484 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16630 | OR | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140566400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1527120000000",
"number": "1902871932",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 SW 13TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972051902",
"telephone_number": "503-221-0161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "541 NE 20TH AVE",
"address_2": "SUITE 210",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97232",
"telephone_number": "503-233-6940",
"fax_number": "503-236-2676"
}
],
"practiceLocations": [
{
"address_1": "5005 NE Sandy Blvd",
"address_purpose": "LOCATION",
"city": "Portland",
"state": "OR",
"postal_code": "972131941",
"country_code": "US",
"telephone_number": "503-233-6940",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CALLAHAN",
"first_name": "KERRY",
"middle_name": "BEN",
"name_prefix": "Mr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-22",
"last_updated": "2018-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "16630",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8138299",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WA DEPT. L&I",
"identifier": "49534",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "043484",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.