Kyle Matthew Baltrusch, MD

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

MD205639 Issued in OR

Practice address

1200 NW Naito Pkwy Ste 310
Portland, OR 97209-2829

Phone

(503) 292-9200

Fax

(503) 292-9205

NPI assigned

Jun 25, 2013

Last updated

Jul 19, 2021By 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

Specialty

Plastic and Reconstructive Surgery

Education

Oregon Health Sciences University School of Medicine, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Portland Plastic Surgery Group, LLCGroup PAC ID 3577787514, 5 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kbaltrusch222890@secure.stcharleshealthcare.org

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.

• Portland Plastic Surgery Group, LLC

  • Plastic Surgery Physician
  • Portland, OR
  • NPI 1437573185
  Medicare reassignment Care Compare group NPD
• Yale S. Popowich, M.D., P.C.

  • Plastic Surgery Physician
  • Portland, OR
  • NPI 1457638884
  NPD (past)

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

{
    "created_epoch": "1372118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626652800000",
    "number": "1952741779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 NW NAITO PKWY STE 310",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972092829",
            "telephone_number": "503-292-9200",
            "fax_number": "503-292-9205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 NW NAITO PKWY STE 310",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972092829",
            "telephone_number": "503-292-9200",
            "fax_number": "503-292-9205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALTRUSCH",
        "first_name": "KYLE",
        "middle_name": "MATTHEW",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-25",
        "last_updated": "2021-07-19",
        "certification_date": "2021-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "OR",
            "license": "MD205639",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500688755",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Danielle Balsz, R.N.
• Denisse Baltazar Molinar
• Kelly Mary Baltazar, N.D., D.C.
• Oleg Balter, MD
• Bill-Bern Balthazard
• Ellen Scott Baltus, LCSW
• Julianne Baltzley
• Sowmya Sameera Balusu, MD
• Alea Erika Balzer, PWS
• Amelia Laurel Bambam

• Plastic and Reconstructive Surgery Physician in Portland, OR
• Providers in Portland, OR by specialty
• Plastic and Reconstructive Surgery Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2021; 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.