Individual provider Active NPI

Kelsie Jordan

  • Physical Therapist
  • Portland, OR
National Provider Identifier
1043867575
Registry record updated Aug 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
63428 Issued in OR
Practice address
10215 SW Park Way Ste D
Portland, OR 97225-5036
Phone
(503) 292-3583
Fax
(503) 292-1022
NPI assigned
Aug 20, 2019
Last updated
Aug 20, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 63428 OR Primary

Addresses

Primary practice location

10215 SW Park Way Ste D
Portland, OR 97225-5036

Mailing address

16083 SW Upper Boones Ferry Rd Ste 300
Tigard, OR 97224-7736
Phone (503) 443-6156

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191205001098 OR Practitioner - Physical Therapist in Private Practice 1153754155 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Therapeutic Associates IncGroup PAC ID 0042116279, 319 clinicians

Practice addresses (Care Compare)

10215 SW Pkwy
Suite D
Portland, OR 97225-5036
Phone (503) 292-3583

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Therapeutic Associates Inc Physical Therapist CurrentSince Sep 7, 2019 Accepting new patients
Therapeutic Associates Inc Physical Therapist CurrentSince Sep 7, 2019 Accepting new patients
Therapeutic Associates Inc Physical Therapist Current Accepting new patients
Therapeutic Associates Inc Physical Therapist Past Accepting new patients
Therapeutic Associates Inc Physical Therapist Past Accepting new patients

Locations

16315 SW Barrows Rd
Ste 205
Beaverton, OR 97007
Phone (503) 521-0500

10215 SW Parkway
Ste D
Portland, OR 97225
Phone (503) 292-3583

8028 NE Glisan St
Ste B
Portland, OR 97213
Phone (503) 253-0924

58147 Columbia River Hwy
Ste A
Saint Helens, OR 97051
Phone (503) 397-1914

20055 SW Pacific Hwy
Ste 110
Sherwood, OR 97140
Phone (503) 625-1691

16083 SW Upper Boones Ferry Rd
Ste 300
Tigard, OR 97224
Phone (503) 443-6153

29100 SW Town Center Loop W
Ste 190
Wilsonville, OR 97070
Phone (503) 570-7600

Interoperability endpoints

  • Direct secure messaging: kelsie.jordan.1@31414.direct.athenahealth.com

Organizations & group practices 5

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": "1566259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566259200000",
    "number": "1043867575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16083 SW UPPER BOONES FERRY RD STE 300",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247736",
            "telephone_number": "503-443-6156",
            "fax_number": "503-639-9699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10215 SW PARK WAY STE D",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255036",
            "telephone_number": "503-292-3583",
            "fax_number": "503-292-1022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "KELSIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-20",
        "last_updated": "2019-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "63428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2019; 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.