NPIMap

Organization Active NPI

Essential Physical Therapy, Inc.

  • Physical Therapist
  • Eugene, OR
National Provider Identifier
1104210756
Registry record updated Oct 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
03956 Issued in OR
Legal business name
ESSENTIAL PHYSICAL THERAPY, INC.
Practice address
120 Shelton McMurphey Blvd Ste 300
Eugene, OR 97401
Phone
(458) 210-2940
Fax
(541) 654-4680
NPI assigned
Mar 21, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2019

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

Authorized official

Name
Mr. Keith Blackwell, PTNPI 1649531328
Title
Owner
Phone
(541) 870-9063

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 03956 OR Primary

Addresses

Primary practice location

120 Shelton McMurphey Blvd Ste 300
Eugene, OR 97401

Mailing address

120 Shelton McMurphey Blvd Ste 300
Eugene, OR 97401-8718
Phone (458) 210-2940

Other practice location 1

150 Shelton McMurphey Blvd
Suite 203
Eugene, OR 97401-5015
Phone (458) 210-2940

Other practice location 2

120 Shelton McMurphey Blvd Ste 300
Eugene, OR 97401
Phone (458) 210-2940

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150424000613 OR Part B Supplier - Clinic/Group Practice 6800115817 Receives reassigned benefits from 2 practitioners
Practice locations: Eugene, OR

National Provider Directory

National Provider Directory

Locations

1166 W 7th Ave
Eugene, OR 97402
Phone (458) 210-2940

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/17276/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1426896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571702400000",
    "number": "1104210756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 SHELTON MCMURPHEY BLVD STE 300",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974018718",
            "telephone_number": "458-210-2940",
            "fax_number": "541-654-4680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 SHELTON MCMURPHEY BLVD STE 300",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "97401",
            "telephone_number": "458-210-2940",
            "fax_number": "541-654-4680"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "150 Shelton McMurphey Blvd",
            "address_2": "Suite 203",
            "address_purpose": "LOCATION",
            "city": "Eugene",
            "state": "OR",
            "postal_code": "974015015",
            "country_code": "US",
            "telephone_number": "458-210-2940",
            "fax_number": "877-796-0176",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "120 Shelton McMurphey Blvd Ste 300",
            "address_purpose": "LOCATION",
            "city": "Eugene",
            "state": "OR",
            "postal_code": "97401",
            "country_code": "US",
            "telephone_number": "458-210-2940",
            "fax_number": "541-654-4680",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ESSENTIAL PHYSICAL THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-21",
        "last_updated": "2019-10-22",
        "status": "A",
        "authorized_official_last_name": "BLACKWELL",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-870-9063",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "03956",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Oct 22, 2019; 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.