NPIMap

Organization Active NPI

Oregon Sports Medicine Associates

Doing business as Sports Medicine Oregon

  • Specialist
  • Tigard, OR
National Provider Identifier
1093713729
Registry record updated Sep 26, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
OREGON SPORTS MEDICINE ASSOCIATES
Doing business as
Sports Medicine Oregon
Practice address
7300 SW Childs Rd
Tigard, OR 97224-7713
Phone
(503) 692-8700
Fax
(503) 692-8710
NPI assigned
Jul 7, 2005
Last updated
Sep 26, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2007

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

Authorized official

Name
Jonathan E. Greenleaf, M.D.NPI 1568469278
Title
President
Phone
(503) 692-8700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

7300 SW Childs Rd
Tigard, OR 97224-7713

Mailing address

7300 SW Childs Rd
Tigard, OR 97224-7713
Phone (503) 692-8700

Other names 1

  • Sports Medicine Oregon Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040420000707 OR Part B Supplier - Clinic/Group Practice 1052306776 Receives reassigned benefits from 28 practitioners
Practice locations: Tigard, OR; Wilsonville, OR
O20120427000177 OR DME Supplier - Physician - General PracticeDME Supplier - Sports Medicine 1052306776 Practice locations: Tigard, OR

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

7300 SW Childs Rd
Tigard, OR 97224
Phone (503) 692-8700

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190764800000",
    "number": "1093713729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7300 SW CHILDS RD",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247713",
            "telephone_number": "503-692-8700",
            "fax_number": "503-692-8710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7300 SW CHILDS RD",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247713",
            "telephone_number": "503-692-8700",
            "fax_number": "503-692-8710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OREGON SPORTS MEDICINE ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "last_updated": "2007-09-26",
        "status": "A",
        "authorized_official_last_name": "GREENLEAF",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-692-8700",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sports Medicine Oregon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tigard, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.