Individual provider Active NPI

Samuel Stewart

  • Physical Therapist
  • Eugene, OR
National Provider Identifier
1093162117
Registry record updated May 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
61671 Issued in OR
Practice address
1777 Coburg Rd Ste 3
Eugene, OR 97401-5477
Phone
(541) 505-8041
Fax
(541) 505-9956
NPI assigned
May 18, 2016
Last updated
May 3, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 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 61671 OR Primary

Addresses

Primary practice location

1777 Coburg Rd Ste 3
Eugene, OR 97401-5477

Mailing address

1200 Corporate Dr Ste 400
Birmingham, AL 35242-5424
Phone (423) 682-8840

Other identifiers 4

IdentifierTypeStateIssuer
0355693OtherORWA L&I
500708180MedicaidOR
0355691OtherORWA L&I
0355692OtherORWA L&I

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160711001498 OR Practitioner - Physical Therapist in Private Practice 6709178890 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1777 Coburg Rd
Suite 3
Eugene, OR 97401-5477
Phone (541) 505-8041

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
61671ORMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Therapeutic Associates Inc Physical Therapist CurrentSince Jun 7, 2016 Accepting new patients
Benchmark Physical Therapy of Or, LLC Physical Therapist CurrentSince Jul 1, 2019 Accepting new patients
Benchmark Physical Therapy of Or, LLC Physical Therapist CurrentSince Jul 1, 2019 Accepting new patients
Therapeutic Associates, Inc Physical Therapist CurrentSince Jun 7, 2016 Accepting new patients
Benchmark Physical Therapy of Oregon LLC Physical Therapist Current Accepting new patients
Therapeutic Associates Inc Physical Therapist Current Accepting new patients
Therapeutic Associates Inc Physical Therapist Past Accepting new patients

Locations

1200 Corporate Dr
Ste 400
Hoover, AL 35242
Phone (423) 238-7568

996 NW Circle Blvd
Ste 101
Corvallis, OR 97330
Phone (541) 757-0878

1777 Coburg Rd
Ste 3
Eugene, OR 97401
Phone (541) 505-8041

2911 Tennyson Ave
Ste 204
Eugene, OR 97408
Phone (541) 515-6194

4242 Commerce St
Ste A
Eugene, OR 97402
Phone (541) 484-9632

3512 Excel Dr
Ste 105
Medford, OR 97504
Phone (541) 245-0419

Organizations & group practices 7

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": "1463529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556841600000",
    "number": "1093162117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CORPORATE DR STE 400",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352425424",
            "telephone_number": "423-682-8840",
            "fax_number": "423-602-2028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1777 COBURG RD STE 3",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974015477",
            "telephone_number": "541-505-8041",
            "fax_number": "541-505-9956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEWART",
        "first_name": "SAMUEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-18",
        "last_updated": "2019-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "61671",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA L&I",
            "identifier": "0355693",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500708180",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA L&I",
            "identifier": "0355691",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA L&I",
            "identifier": "0355692",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eugene, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 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.