MEDICARE: KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261Q00000X	Clinic/Center
2	207R00000X	Internal Medicine Physician
3	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1366238313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST

Provider Business Mailing Address
First Line	:	500 NE MULTNOMAH ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-2023
Country	:	US
Telephone Number	:	800-813-2000
Fax Number	:	855-524-5255

Provider Business Practice Location Address
First Line	:	2850 NW NICOLAI ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-2018
Country	:	US
Telephone Number	:	800-813-2000
Fax Number	:	855-524-5255

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	STEPHEN SHAWN BARTON
Credential	:
Telephone Number	:	503-568-2593

Provider Enumeration Date	:	04/16/2025
Last Update Date	:	04/16/2025

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