Active NPI
Kenneth Michael Ettinger, M.D.
- Allergy & Immunology Physician
- Portland, OR
National Provider Identifier
1972617330
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Allergy & Immunology Physician
- License
- MD13428
- Practice address
- 3550 N Interstate Ave
Portland, OR 97227-1196 - Phone
- (503) 285-9321
- Fax
- (503) 331-6450
- NPI assigned
- Aug 19, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy & Immunology Physician | 207K00000X | MD13428 | OR | Primary |
| Allergy & Immunology Physician | 207K00000X | MD00027111 | WA |
Addresses
Primary practice location
3550 N Interstate Ave
Portland, OR 97227-1196
Mailing address
3550 N Interstate Ave
Portland, OR 97227-1196
Phone (503) 285-9321
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq | Health Information Exchange (HIE) | Northwest Permanente PC |
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 |
|---|---|---|---|
| MD13428 | OR | MD | Allergy & Immunology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643932800000",
"number": "1972617330",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3550 N INTERSTATE AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972271196",
"telephone_number": "503-285-9321",
"fax_number": "503-331-6450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3550 N INTERSTATE AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972271196",
"telephone_number": "503-285-9321",
"fax_number": "503-331-6450"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETTINGER",
"first_name": "KENNETH",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-19",
"last_updated": "2022-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "207K00000X",
"taxonomy_group": "",
"desc": "Allergy & Immunology",
"state": "OR",
"license": "MD13428",
"primary": true
},
{
"code": "207K00000X",
"taxonomy_group": "",
"desc": "Allergy & Immunology",
"state": "WA",
"license": "MD00027111",
"primary": false
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
"affiliation": "Y",
"endpointDescription": "Carequality",
"affiliationName": "Northwest Permanente PC",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "C-CDA",
"address_1": "19185 SW 90th Ave",
"city": "Tualatin",
"state": "OR",
"country_code": "US",
"postal_code": "970627558",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 Feb 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.