MRS. SERENA PHROMSIVARAK KELLY ACPNP
NPI 1457545899
Nurse Practitioner - Acute Care in Portland, OR
About Mrs. Serena Phromsivarak Kelly Acpnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MRS. SERENA PHROMSIVARAK KELLY ACPNP (NPI 1457545899) is an individual acute care provider in Portland, Oregon, licensed in Oregon (200750101) and active in the NPI registry since August 2007. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mrs. Serena Phromsivarak Kelly Acpnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Serena Kelly reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Portland, OR 97239
- Reassigned Medicare billing, Oregon enrollment
- 2,212 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 97239 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
PORTLAND, OR 97239
PORTLAND, OR 97239
PORTLAND, OR 97239
PORTLAND, OR 97239
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 Serena Kelly's NPI number?
The NPI number for Serena Kelly is 1457545899. It was assigned to this individual provider in the NPPES registry on August 29, 2007.
Where is Serena Kelly located?
Serena Kelly practices at 3181 SW Sam Jackson Park Rd Mail Code Dc8n, Portland, OR 97239. The listed phone number is (503) 418-5881.
What is Serena Kelly's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Acute Care, with taxonomy code 363LA2100X.
Is Serena Kelly enrolled in Medicare?
Yes. Serena Kelly is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Serena Kelly's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Serena Kelly reassigns Medicare benefits to University Professional Services (Portland, OR). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Serena Kelly's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Serena Kelly was last updated on November 16, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.
# Mrs. Serena Phromsivarak Kelly, ACPNP · NPI 1457545899
Acute Care physician in Portland, Oregon. Individual provider, active in the CMS NPPES registry since August 29, 2007.
## Identity
- **NPI:** 1457545899 (Entity type: Individual)
- **Enumerated:** August 29, 2007
- **Primary specialty:** Nurse Practitioner - Acute Care · taxonomy 363LA2100X
- **State license:** 200750101 (Oregon)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 3181 SW SAM JACKSON PARK RD, MAIL CODE DC8N, Portland, OR 97239-3011
- **Phone:** (503) 418-5881
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** University Professional Services (NPI 1376709535, Portland, OR), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 16, 2016
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Source: [NPI Profile](https://npiprofile.com/npi/1457545899) · Data from the CMS NPPES public registry.