NPIMap

Individual provider Active NPI

Thomas Derek Kowalik, M.D.

  • Adult Reconstructive Orthopaedic Surgery Physician
  • Hillsboro, OR
National Provider Identifier
1023307899
Registry record updated Nov 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Reconstructive Orthopaedic Surgery PhysicianTaxonomy code 207XS0114X
License
171470 Issued in OR
Practice address
1200 NE 48TH Ave Ste 1100
Hillsboro, OR 97124-5062
Phone
(503) 844-8219
Fax
(503) 844-8234
NPI assigned
Apr 1, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Reconstructive Orthopaedic Surgery Physician 207XS0114X 171470 OR Primary

Addresses

Primary practice location

1200 NE 48TH Ave Ste 1100
Hillsboro, OR 97124-5062

Mailing address

1200 NE 48TH Ave Ste 1100
Hillsboro, OR 97124-5062
Phone (503) 844-8219

Other identifiers 1

IdentifierTypeStateIssuer
MD171470OtherORLICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160831002603 OR Practitioner - Orthopedic Surgery 8224282579 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tuality Medical Group LLCGroup PAC ID 7416173414, 289 clinicians
University Professional ServicesGroup PAC ID 4880760107, 1,683 clinicians

Practice addresses (Care Compare)

1200 NE 48TH Ave
Suite 1100
Hillsboro, OR 97124-5062
Phone (503) 844-8219

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone (503) 494-8311

335 SE 8TH Ave
Hillsboro, OR 97123-4246
Phone (503) 681-1111

Hospital & facility affiliations

  • Amedisys Home Health Care Home health agency, Portland, OR, CCN 387003
  • Hillsboro Medical Center Hospital, Hillsboro, OR, CCN 380021
  • Ohsu Hospital and Clinics Hospital, Portland, OR, CCN 380009
  • Columbia Memorial Hospital Hospital, Astoria, OR, CCN 381320

Merit-based Incentive Payment System (MIPS)

Final score
99.11 of 100Reported as apm
Quality
84.29
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
99.11 of 100Reported as apm
Quality
84.29
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement37
Knee replacement52
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
171470ORMDAdult Reconstructive Orthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tuality Healthcare Current Accepting new patients
Tuality Healthcare CurrentSince Oct 29, 2017 Accepting new patients
Tuality Medical Group LLC CurrentSince Oct 29, 2017 Accepting new patients
Tuality Healthcare Current Accepting new patients
Tuality Medical Group LLC CurrentSince Oct 29, 2017 Accepting new patients
University Professional Services CurrentSince Apr 1, 2018 Accepting new patients
University Professional Services CurrentSince Apr 1, 2018 Accepting new patients
Tuality Healthcare CurrentSince Oct 29, 2017 Accepting new patients
University Professional Services Current Accepting new patients

Locations

15700 SW Greystone Ct
Beaverton, OR 97006
Phone (503) 203-1000

1200 NE 48th Ave
Ste 1100
Hillsboro, OR 97124
Phone (503) 844-8219

335 SE 8th Ave
Hillsboro, OR 97123
Phone (503) 681-1111

3181 SW Sam Jackson Park Rd
Portland, OR 97239
Phone (503) 494-5674

Interoperability endpoints

  • Direct secure messaging: tkowalikmd73071@direct.ohsu.edu

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 19

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1301616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1023307899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 NE 48TH AVE STE 1100",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971245062",
            "telephone_number": "503-844-8219",
            "fax_number": "503-844-8234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 NE 48TH AVE STE 1100",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971245062",
            "telephone_number": "503-844-8219",
            "fax_number": "503-844-8234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOWALIK",
        "first_name": "THOMAS",
        "middle_name": "DEREK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-01",
        "last_updated": "2021-11-30",
        "certification_date": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0114X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "OR",
            "license": "171470",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "MD171470",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hillsboro, OR

Sources for this page

Verify at the official NPI Registry.