NPIMap

Organization Active NPI

Willamette Orthotics & Prosthetics LLC

  • Prosthetic/Orthotic Supplier
  • Salem, OR
National Provider Identifier
1003955865
Registry record updated May 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
WILLAMETTE ORTHOTICS & PROSTHETICS LLC
Practice address
2420 Grear St NE
Salem, OR 97301
Phone
(503) 364-6006
Fax
(503) 364-6006
NPI assigned
Feb 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ivan Sabel
Title
Ceo
Phone
(503) 364-6006

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Customized Equipment (DME) 332BC3200X
Prosthetic/Orthotic Supplier 335E00000X Primary

Addresses

Primary practice location

2420 Grear St NE
Salem, OR 97301

Mailing address

PO Box 7339
Salem, OR 97303-0102
Phone (503) 364-6006

Other identifiers 1

IdentifierTypeStateIssuer
230560MedicaidOR

Other names 1

  • Summit Orthotics & Prosthetics Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930041231 OR DME Supplier - Certified Orth/Pros/Pedorthist 5092826503 Practice locations: Salem, OR

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Willamette Orthotic & Prostheti2420 Grear St NE, Salem, OR 97301-2766(503) 364-6006 Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom|Lymphedema Compression Treatment Items Accepts assignmentParticipating since Jan 1, 2006

National Provider Directory

National Provider Directory
Tax ID family
Willamette Orthotics Prosthetics LLC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

935 Willagillespie Rd
Ste B
Eugene, OR 97401
Phone (541) 431-7377

3011 NE West Devils Lake Rd
Lincoln City, OR 97367
Phone (541) 994-2222

2420 Grear St NE
Salem, OR 97301
Phone (503) 364-6006

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778544000000",
    "number": "1003955865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7339",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973030102",
            "telephone_number": "503-364-6006",
            "fax_number": "503-364-6046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2420 GREAR ST NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "97301",
            "telephone_number": "503-364-6006",
            "fax_number": "503-364-6006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLAMETTE ORTHOTICS & PROSTHETICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2026-05-12",
        "certification_date": "2026-05-12",
        "status": "A",
        "authorized_official_last_name": "SABEL",
        "authorized_official_first_name": "IVAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "503-364-6006"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "230560",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Summit Orthotics & Prosthetics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Summit Orthotics & Prosthetics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.