TIMOTHY L KELLY (NPI# 1992798169) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992798169 |
| Entity Type | Individual |
| Full Name | TIMOTHY L KELLY |
| Credential | MD |
| Practice Address |
831 Nw Council Dr Suite 300 Gresham OR 97030-3721 |
| Practice Telephone | 5033828100 |
| Mailing Telephone | 5033828100 |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2008-06-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207LP2900X |
Anesthesiology Specialization: Pain Medicine |
MD00041959 | WA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | LABOR & IND | 0197446 | 01 |
| OR | 213668 | 05 | |
| RR MEDICARE | P00326179 | 01 | |
| WA | 8358756 | 05 | |
| WA | CRIME VICTIMS | 8905947 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720561608 | Timothy Kelly | Social Worker | 25a Vreeland Rd, Florham Park, NJ 07932-1910 | 2018-09-07 |
| 1942525928 | Timothy Anton Kelly | Home Health | 7954 Brooklyn Boulavard, 7954, Brooklyn Park, MN 55445 | 2010-04-01 |
| 1003026261 | Timothy Richard Kelly | Psychiatry & Neurology | 510 Azalea Dr Ste 200, Oxford, MS 38655-6903 | 2007-05-23 |
| 1700953163 | Timothy James Kelly | Chiropractor | 1038 Washington Street, Fairfield, CA 94533-5545 | 2006-11-29 |
| 1063592558 | Timothy P Kelly | Chiropractor | 3098 Piedmont Rd Ne Ste 430, Atlanta, GA 30305-2600 | 2006-10-17 |
| 1588653281 | Timothy Lynn Kelly | Dentist | 1600 Mountain View Rd, Suite 104, Rapid City, SD 57702-4381 | 2005-10-17 |
| 1497758825 | Timothy G Kelly | Ophthalmology | 1915 Tradd Ct, Wilmington, NC 28401-6638 | 2005-05-31 |
| 1073140497 | Timothy Stephen Kelly | Student in an Organized Health Care Education/Training Program | 1 Gustave L Levy Pl # 1149, New York, NY 10029-6504 | 2020-03-25 |
| 1649805888 | Timothy Dwyer Kelly | Student in an Organized Health Care Education/Training Program | 13001 E 17th Pl, Aurora, CO 80045-2570 | 2020-03-09 |
| 1518590629 | Timothy Kelly | Peer Specialist | 14600 Nw Cornell Rd, Portland, OR 97229-5442 | 2020-02-17 |
| Street Address |
831 NW COUNCIL DR SUITE 300 |
| City | GRESHAM |
| State | OR |
| Zip Code | 97030-3721 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821341223 | Columbia Pain and Spine Institute | Clinical Medical Laboratory | 831 Nw Council Dr, #300, Gresham, OR 97030 | 2012-10-23 |
| 1750643060 | John C. Anderson, M.d., P.C. | Orthopaedic Surgery | 831 Nw Council Dr, Suite 130, Gresham, OR 97030-3721 | 2012-06-12 |
| 1053699645 | Whitney Blaire Fancher | Dermatology | 831 Nw Council Dr, Suite 301, Gresham, OR 97030-3721 | 2011-07-30 |
| 1386897809 | Maria S Kling | Nurse Practitioner | 831 Nw Council Dr, Suite 101, Gresham, OR 97030-3721 | 2008-10-28 |
| 1932376894 | Sarah Schultz | Internal Medicine | 831 Nw Council Dr, Suite 125, Gresham, OR 97030-3721 | 2008-05-09 |
| 1649442476 | Melanie Marie Falgout | Family Medicine | 831 Nw Council Dr, Suite 125, Gresham, OR 97030-3721 | 2008-04-01 |
| 1639352594 | Rose City Breast Care, LLC | Surgery | 831 Nw Council Dr, Suite 301, Gresham, OR 97030-3721 | 2007-12-13 |
| 1851587364 | Grayden Woodruff King | Podiatrist | 831 Nw Council Dr, Ste 203, Gresham, OR 97030-3721 | 2007-09-18 |
| 1720278633 | Karen Shaw | Nurse Practitioner | 831 Nw Council Dr, Suite 300, Gresham, OR 97030-3721 | 2007-07-26 |
| 1497954994 | Maryellen Hibbard | Nurse Practitioner | 831 Nw Council Dr, Suite 300, Gresham, OR 97030-3721 | 2007-07-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174032312 | Tiffany Chen | Occupational Therapist | 304 Ne Hood Ave., Gresham, OR 97030 | 2017-09-20 |
| 1225568454 | Goldstar Vascular Access, Inc | Home Infusion | 2870 Ne Hogan Dr, Ste E #205, Gresham, OR 97030 | 2017-06-20 |
| 1861940454 | Jessica Morrow | Massage Therapist | 1748 Nw Fairview Dr., Gresham, OR 97030 | 2016-09-13 |
| 1033665898 | Bonita Baxter | Counselor | 400 Ne 7th Street, Gresham, OR 97030 | 2016-08-31 |
| 1710335484 | Ethan William Hoccom | Counselor | 1527 Ne Lamesa Place 17th St, Gresham, OR 97030 | 2016-06-02 |
| 1992159610 | Kathleen Kline, Lmt | Massage Therapist | 1217 Ne Burnside Road Suite 701-d, Gresham, OR 97030 | 2016-04-19 |
| 1215390109 | The Wallace Medical Concern | Nurse Practitioner | 254 Nw Burnside Road, Gresham, OR 97030 | 2016-03-30 |
| 1932568912 | Atchison Dialysis, LLC | Clinic/Center | 878 Nw Burnside Rd, Gresham, OR 97030 | 2016-02-18 |
| 1912374034 | Hilary Dawn Montgomery | Counselor | 1326 Nw Civic Dr # 5569, Gresham, OR 97030 | 2015-08-24 |
| 1992171730 | Melissa E Childs | Massage Therapist | 1217 Nw Burnside Rd Ste 701, Gresham, OR 97030 | 2015-08-17 |
| Find all providers in zip 97030 | ||||
| Taxonomy Code | 207LP2900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Anesthesiology |
| Specialization | Pain Medicine |
| An anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic and/or cancer pain in both hospital and ambulatory settings. Patient care needs are also coordinated with other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Anesthesiology, 2007. http://www.theaba.org/; American Osteopathic Board of Anesthesiology, 2007, http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Anesthesiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Anesthesiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124105044 | Gregory Gullo Md PC | Anesthesiology | 24076 Se Stark St, Suite 320, Gresham, OR 97030-3373 | 2006-11-01 |
| 1841238128 | Nhat Quang Nguyen | Anesthesiology | 831 Nw Council Dr, Suite 300, Gresham, OR 97030-3721 | 2006-06-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912346461 | Vishal Khemlani | Anesthesiology | 6464 Sw Borland Rd Ste A2, Tualatin, OR 97062-8854 | 2013-06-18 |
| 1316140965 | Russell Robert Kinder | Anesthesiology | 10000 Se Main St Ste 128, Portland, OR 97216-2462 | 2007-06-08 |
| 1124075791 | Gregory Gullo | Anesthesiology | 2020 8th Ave, Suite 200, West Linn, OR 97068-4657 | 2006-05-28 |
| 1851353502 | Ahmed Ebeid | Anesthesiology | 851 Ne Baker St Ste 1, Mcminnville, OR 97128-4991 | 2006-04-06 |
| 1013911361 | Brett T Quave | Anesthesiology | 701 Golf View Dr, Medford, OR 97504-9643 | 2005-06-01 |
| 1568083517 | Deschutes Pain Specialists LLC | Anesthesiology | 2235 Nw Shevlin Park Rd Ste 100, Bend, OR 97703-7111 | 2020-04-30 |
| 1942675467 | Pain Care Specialists of Oregon, LLC | Anesthesiology | 2480 Liberty St Ne Ste 180, Salem, OR 97301-8388 | 2015-12-09 |
| 1487023388 | Comprehensive Pain Care, LLC | Anesthesiology | 842 E Main St, Medford, OR 97504-7134 | 2015-09-21 |
| 1235520503 | Andrew Oh Md PC | Anesthesiology | 140 Nw 14th Ave, Portland, OR 97209-2601 | 2015-02-09 |
| 1558751958 | Washington Center for Pain Management LLC | Anesthesiology | 11786 Sw Barnes Rd, Suite 270, Portland, OR 97225-5929 | 2015-01-23 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.