Kenneth Michael Carlson, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD22868 Issued in OR

Practice address

1475 Mount Hood Ave
Woodburn, OR 97071-9099

Phone

(503) 981-1509

NPI assigned

Jul 6, 2006

Last updated

May 8, 2024By the provider in NPPES

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

Other identifiers 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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kcarlson44161@yvfwc.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Yakima Valley Farm Workers Clinic

  dba Mirasol Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Hermiston, OR
  • NPI 1427001940
  Medicare reassignment NPD
• Yakima Valley Farm Workers Clinic

  dba Coastal Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Astoria, OR
  • NPI 1316484165
  NPD
• Yakima Valley Farm Workers Clinic

  dba Community Health Center of Clatskanie

  • Federally Qualified Health Center (FQHC)
  • Clatskanie, OR
  • NPI 1578000345
  NPD

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715126400000",
    "number": "1952332702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1475 MOUNT HOOD AVE",
            "city": "WOODBURN",
            "state": "OR",
            "postal_code": "970719099",
            "telephone_number": "503-982-0626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1475 MOUNT HOOD AVE",
            "city": "WOODBURN",
            "state": "OR",
            "postal_code": "970719099",
            "telephone_number": "503-981-1509"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "891 23rd St NE",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OR",
            "postal_code": "973011793",
            "country_code": "US",
            "telephone_number": "503-364-2181",
            "fax_number": "503-364-0364",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "121 SE Viewmont Ave",
            "address_purpose": "LOCATION",
            "city": "Corvallis",
            "state": "OR",
            "postal_code": "973331968",
            "country_code": "US",
            "telephone_number": "541-766-3546",
            "fax_number": "541-766-6143",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "KENNETH",
        "middle_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD22868",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "287244",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jose Arturo Campos Alfaro, CADC-R, CRM
• Capitol Physical & Hand Therapy II (Woodburn Therapy Group)
• Capstone Counseling, LLC
• Alfonso Capuras, APRN
• Omar Carbajal
• William George Carnett, D.O.
• Alison B Carrigg, DO
• Jesus Carrillo
• Cascadia Behavioral Health Care
• Cascadia Behavioral Healthcare Inc

• Pediatrics Physician in Woodburn, OR
• Providers in Woodburn, OR by specialty
• Pediatrics Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.