Individual provider Active NPI

Benjamin Nelson, MSPT, OCS

  • Orthopedic Physical Therapist
  • Portland, OR
National Provider Identifier
1053353904
Registry record updated Apr 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
3833 Issued in OR
Practice address
4445 SW Barbur Blvd Ste 204
Portland, OR 97239-4047
Phone
(503) 235-3386
NPI assigned
Jun 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2017

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 PT00009802 WA
Orthopedic Physical Therapist 2251X0800X 3833 OR Primary

Addresses

Primary practice location

4445 SW Barbur Blvd Ste 204
Portland, OR 97239-4047

Mailing address

12849 NW Cornell Rd
Portland, OR 97229-5813
Phone (503) 208-6278

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT00009802WAMDPhysical Therapist
3833ORMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Colin Hoobler PC Past Accepting new patients
Therapeutic Associates Inc Physical Therapist Past Accepting new patients
Lifestyles Physical Therapy, PC Past Accepting new patients
Therapeutic Associates Inc Physical Therapist Past Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491264000000",
    "number": "1053353904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12849 NW CORNELL RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972295813",
            "telephone_number": "503-208-6278",
            "fax_number": "503-208-6276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4445 SW BARBUR BLVD STE 204",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972394047",
            "telephone_number": "503-235-3386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "BENJAMIN",
        "credential": "MSPT, OCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2017-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00009802",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "OR",
            "license": "3833",
            "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 Apr 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.