Individual provider Active NPI

Kaitlyn Anne Stettnichs, MD

  • Family Medicine Physician
  • Portland, OR
National Provider Identifier
1962082503
Registry record updated Jul 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD224763 Issued in OR
Practice address
4411 SW Vermont St
Portland, OR 97219-1020
Phone
(503) 494-9992
NPI assigned
Apr 8, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A192428 CA
Family Medicine Physician 207Q00000X MD224763 OR Primary

Addresses

Primary practice location

4411 SW Vermont St
Portland, OR 97219-1020

Mailing address

4411 SW Vermont St
Portland, OR 97219-1020

Other practice location 1

2951 Benefit Way Ste 200
Sacramento, CA 95834-1272
Phone (916) 285-8100

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250804003563 OR Practitioner - Family Practice 8628449717 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Rochester School of Medicine and Dentistry, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University Professional ServicesGroup PAC ID 4880760107, 1,683 clinicians

Practice addresses (Care Compare)

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone (503) 494-8311

Hospital & facility affiliations

  • Ohsu Hospital and Clinics Hospital, Portland, OR, CCN 380009

Merit-based Incentive Payment System (MIPS)

Final score
87.39 of 100Reported as group
Quality
75.67
Promoting interoperability
100
Improvement activities
40
Cost
74.51

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A192428CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Professional Services CurrentSince Aug 1, 2025 Accepting new patients
University Professional Services Current Accepting new patients
University Professional Services CurrentSince Aug 1, 2025 Accepting new patients
Sutter North Medical Foundation PastSince Apr 1, 2021 Accepting new patients
Sutter West Bay Medical Foundation Family Medicine PastSince Apr 1, 2021 Accepting new patients
University Professional Services Past Accepting new patients

Locations

15700 SW Greystone Ct
Beaverton, OR 97006
Phone (503) 203-1000

4411 SW Vermont St
Portland, OR 97219
Phone (503) 494-9992

3181 SW Sam Jackson Park Rd
Portland, OR 97239
Phone (503) 494-5674

Interoperability endpoints

  • Direct secure messaging: kstettnichs581538@hisp.ehr.sutterhealth.org
  • Direct secure messaging: kstettnichs200340@direct.ohsu.edu

Organizations & group practices 6

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 1

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": "1617840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752537600000",
    "number": "1962082503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4411 SW VERMONT ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972191020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4411 SW VERMONT ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972191020",
            "telephone_number": "503-494-9992"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2951 Benefit Way Ste 200",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958341272",
            "country_code": "US",
            "telephone_number": "916-285-8100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STETTNICHS",
        "first_name": "KAITLYN",
        "middle_name": "ANNE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-08",
        "last_updated": "2025-07-15",
        "certification_date": "2025-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A192428",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD224763",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.