DR. MACKENZIE KELLY MD
NPI 1942761580
Orthopaedic Surgery - Adult Reconstructive Orthopaedic Surgery in Portland, OR
About Dr. Mackenzie Kelly Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. MACKENZIE KELLY MD (NPI 1942761580) is an individual adult reconstructive orthopaedic surgery provider in Portland, Oregon, licensed in Oregon (MD216103) and active in the NPI registry since March 2019. She is enrolled in Medicare PECOS, is affiliated with Holy Cross Hospital - Salt Lake, and is a graduate of Oregon Health Sciences University School Of Medicine (2019).
NPPES Registry Identity
Specialties & Licenses
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
Dr. Mackenzie Kelly Md 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 Reassignment
Medicare enrollment records show Mackenzie Kelly reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Farmington, UT 84025
- Reassigned Medicare billing, Utah enrollment
- 2,620 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.
Hospital Affiliations CMS Care Compare 2
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Holy Cross Hospital - Salt Lake
Acute Care Hospitals · Salt Lake City, UTUniversity Of Utah Hospitals And Clinics
Acute Care Hospitals · Salt Lake City, UTOther 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 Mackenzie Kelly's NPI number?
The NPI number for Mackenzie Kelly is 1942761580. It was assigned to this individual provider in the NPPES registry on March 27, 2019.
Where is Mackenzie Kelly located?
Mackenzie Kelly practices at 3181 SW Sam Jackson Park Rd, Portland, OR 97239. The listed phone number is (503) 494-8211.
What is Mackenzie Kelly's specialty?
The primary specialty registered for this NPI is Orthopaedic Surgery, specializing in Adult Reconstructive Orthopaedic Surgery, with taxonomy code 207XS0114X.
Is Mackenzie Kelly enrolled in Medicare?
Yes. Mackenzie Kelly 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 organization bills Medicare for Mackenzie Kelly's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Mackenzie Kelly reassigns Medicare benefits to University Of Utah Adult Services (Farmington, UT). 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 Mackenzie Kelly's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Mackenzie Kelly accept?
Health plans from Moda Health Plan, Inc. list Mackenzie Kelly 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 Mackenzie Kelly affiliated with any hospitals?
According to CMS data, Mackenzie Kelly is affiliated with Holy Cross Hospital - Salt Lake and University Of Utah Hospitals And Clinics.
When was this NPI record last updated?
The NPPES record for Mackenzie Kelly was last updated on October 15, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 27 days 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.
# Dr. Mackenzie Kelly, MD · NPI 1942761580
Adult Reconstructive Orthopaedic Surgery physician in Portland, Oregon. Individual provider, active in the CMS NPPES registry since March 27, 2019.
## Identity
- **NPI:** 1942761580 (Entity type: Individual)
- **Enumerated:** March 27, 2019
- **Primary specialty:** Orthopaedic Surgery - Adult Reconstructive Orthopaedic Surgery · taxonomy 207XS0114X
- **State license:** MD216103 (Oregon)
- **Sole proprietor:** No
## Practice location
- **Address:** 3181 SW SAM JACKSON PARK RD, Portland, OR 97239-3098
- **Phone:** (503) 494-8211
## 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:** University Of Utah Adult Services (NPI 1649724139, Farmington, UT), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Oregon Health Sciences University School Of Medicine, class of 2019
## Record status
- **NPPES last updated:** October 15, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1942761580) · Data from the CMS NPPES public registry.