Individual provider Active NPI

Richard Bandy, PT

  • Physical Therapist
  • Clackamas, OR
National Provider Identifier
1033219126
Registry record updated Oct 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
65508 Issued in OR
Practice address
11977 SE Sunnyside Rd
Clackamas, OR 97015-9312
Phone
(503) 486-6944
NPI assigned
Sep 25, 2006
Last updated
Oct 24, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT00007581 WA
Physical Therapist 225100000X 65508 OR Primary

Addresses

Primary practice location

11977 SE Sunnyside Rd
Clackamas, OR 97015-9312

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2222

Other practice location 1

6985 Coal Creek Pkwy SE
Newcastle, WA 98059-3136
Phone (425) 378-0500

Other identifiers 2

IdentifierTypeStateIssuer
8341554MedicaidWA
205223OtherWALABOR & INDUSTRIES

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241120001568 OR Practitioner - Physical Therapist in Private Practice 3072555499 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
85.22 of 100Reported as group
Quality
87.65
Improvement activities
40
Cost
73.37

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
29107CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Erhardt Physical Therapy and Sports Medicine, LLC Physical Therapist CurrentSince Oct 14, 2024 Accepting new patients
Dimond Physical Therapy and Performance Lab, LLC Physical Therapist PastSince Jun 15, 2015 Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

735 SW 158th Ave
Ste 160
Beaverton, OR 97006
Phone (503) 597-0035

11977 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 486-6944

3322 N Vancouver Ave
Portland, OR 97227

9500 SE 82nd Ave
Ste B
Portland, OR 97086
Phone (971) 323-6234

51385 SW Old Portland Rd
Scappoose, OR 97056
Phone (503) 543-7768

7800 SW Durham Rd
Ste 500
Tigard, OR 97224
Phone (503) 937-0090

30060 SW Boones Ferry Rd
Ste C34
Wilsonville, OR 97070
Phone (503) 404-3068

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729728000000",
    "number": "1033219126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2222",
            "fax_number": "630-759-9510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11977 SE SUNNYSIDE RD",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970159312",
            "telephone_number": "503-486-6944"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6985 Coal Creek Pkwy SE",
            "address_purpose": "LOCATION",
            "city": "Newcastle",
            "state": "WA",
            "postal_code": "980593136",
            "country_code": "US",
            "telephone_number": "425-378-0500",
            "fax_number": "425-378-8168",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BANDY",
        "first_name": "RICHARD",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-25",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00007581",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "65508",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8341554",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "205223",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clackamas, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; 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.