KATHY KIRYANG BAK M.D.
NPI 1861412884
Family Medicine in Portland, OR
About Kathy Kiryang Bak M.d. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KATHY KIRYANG BAK M.D. (NPI 1861412884) is an individual family medicine provider in Portland, Oregon, licensed in Oregon (MD164294) and active in the NPI registry since July 2006. She is enrolled in Medicare PECOS, is affiliated with Providence St Vincent Medical Center, and is a graduate of Other (2002).
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Kathy Kiryang Bak M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
3Medicare enrollment records show Kathy Bak reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Portland, OR 97225
- Reassigned Medicare billing, Oregon enrollment
- 1,501 clinicians in this Medicare group
Portland, OR 97225
- Reassigned Medicare billing, Oregon enrollment
- 753 clinicians in this Medicare group
Beaverton, OR 97005
- Reassigned Medicare billing, Oregon enrollment
- Medicare enrollment name: Kaiser Foundation Health Plan Of The Northwest
- 3,207 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.
Areas of Expertise CMS Part B claims 5
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Hospital Affiliations CMS Care Compare 2
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Providence St Vincent Medical Center
Acute Care Hospitals · Portland, ORProvidence Portland Medical Center
Acute Care Hospitals · Portland, ORPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 97229 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
Other Providers at the Same Location NPPES 6
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Kathy Bak's NPI number?
The NPI number for Kathy Bak is 1861412884. It was assigned to this individual provider in the NPPES registry on July 20, 2006.
Where is Kathy Bak located?
Kathy Bak practices at 12400 NW Cornell Rd Ste 100, Portland, OR 97229. The listed phone number is (503) 291-4000.
What is Kathy Bak's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Kathy Bak enrolled in Medicare?
Yes. Kathy Bak is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Kathy Bak's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kathy Bak reassigns Medicare benefits to 3 organizations: Providence Health & Services - Oregon (Portland, OR), Providence Health & Services - Oregon (Portland, OR) and Beaverton Rehab & Specialty Care, LLC (Beaverton, OR). Each 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 Kathy Bak's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Kathy Bak accept?
Health plans from Providence Health Plan list Kathy Bak as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
Is Kathy Bak affiliated with any hospitals?
According to CMS data, Kathy Bak is affiliated with Providence St Vincent Medical Center and Providence Portland Medical Center.
When was this NPI record last updated?
The NPPES record for Kathy Bak was last updated on October 27, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.
# Kathy Kiryang Bak, M.D. · NPI 1861412884
Family Medicine physician in Portland, Oregon. Individual provider, active in the CMS NPPES registry since July 20, 2006.
## Identity
- **NPI:** 1861412884 (Entity type: Individual)
- **Enumerated:** July 20, 2006
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **State license:** MD164294 (Oregon)
- **Sole proprietor:** No
## Practice location
- **Address:** 12400 NW CORNELL RD STE 100, Portland, OR 97229-5689
- **Phone:** (503) 291-4000
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 3 organizations under Medicare reassignment (form CMS-855R): Providence Health & Services - Oregon (NPI 1083714141, Portland, OR); Providence Health & Services - Oregon (NPI 1235259532, Portland, OR); Beaverton Rehab & Specialty Care, LLC (NPI 1366469330, Beaverton, OR) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2002
## Record status
- **NPPES last updated:** October 27, 2023
- **Other identifiers:** Medicaid 500674133 (OR)
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Source: [NPI Profile](https://npiprofile.com/npi/1861412884) · Data from the CMS NPPES public registry.