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KELLY RENE KELLER PA
NPI 1093916744
Physician Assistant - Medical in Portland, OR

Active since May 30, 2007PECOS Enrolled
97.83/100
CMS Quality Rating
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239(503) 418-5710(503) 494-4953 Get Directions Write a Review

NPPES record last updated: December 29, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kelly Rene Keller Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY RENE KELLER PA (NPI 1093916744) is an individual medical provider in Portland, Oregon, licensed in Oregon (PA152808) and active in the NPI registry since May 2007. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1093916744
Entity TypeIndividualFemale
Primary Taxonomy363AM0700X
Provider Legal NameKELLY RENE KELLERCredential: PA
Location Address3181 SW SAM JACKSON PARK RDPortland, OR 97239-3011
Mailing Address3181 Sw Sam Jackson Park RdPortland, OR 97239-3011 · (503) 418-5710 · Fax (503) 494-4953
Phone(503) 418-5710
Fax(503) 494-4953
Sole ProprietorNo
Enumeration DateMay 30, 2007
Last NPPES UpdateDecember 29, 2020
NPPES CertifiedDecember 29, 2020
✔ NPI 1093916744 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in OR · PA152808
Also ListedPhysician AssistantTaxonomy 363A00000X · License PA04395 (TX)
3181 SW SAM JACKSON PARK RD, Portland, OR 97239
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kelly Rene Keller Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

97.83/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality80.97
Promoting Interoperability100
Improvement Activities40

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DONALD RICHARD SULLIVAN MD
Internal Medicine (Pulmonary Disease)
3181 SW SAM JACKSON PARK RD, UHN67
PORTLAND, OR 97239
Multnomah County (503) 494-6949
MRS. ANJALEE NIX ROWE NP
Nurse Practitioner (Acute Care)
3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239
Multnomah County (503) 494-3988
REEM HASAN MD
Internal Medicine
3181 SW SAM JACKSON PARK RD, PPV 350
PORTLAND, OR 97239
Multnomah County (503) 494-8562
DR. AMANDA D BALL PSY.D
Psychologist (Clinical)
3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239
Multnomah County (503) 494-6176
SUNSHINE WELSCH LMT
Massage Therapist
3181 SW SAM JACKSON PARK RD, 7D19
PORTLAND, OR 97239
Multnomah County (503) 494-8349
DR. ROBERT GENE MEALER M.D., PH.D.
Psychiatry & Neurology (Psychiatry)
3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239
Multnomah County (503) 494-6176
GREGORY HALL MD
Radiology (Diagnostic Radiology)
3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239
Multnomah County (503) 418-0990
DR. BURHAN AHMED MIAN MD
Student in an Organized Health Care Education/Training Program
3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239
Multnomah County (503) 494-8311

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Keller's NPI number?

The NPI number for Kelly Keller is 1093916744. It was assigned to this individual provider in the NPPES registry on May 30, 2007.

Where is Kelly Keller located?

Kelly Keller practices at 3181 SW Sam Jackson Park Rd, Portland, OR 97239. The listed phone number is (503) 418-5710.

What is Kelly Keller's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Kelly Keller enrolled in Medicare?

Yes. Kelly Keller is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kelly Keller was last updated on December 29, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.