Dmitriy Shore, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA00724 Issued in OR

Practice address

10305 SW Park Way Ste 300
Portland, OR 97225-5033

Phone

(503) 295-0730

Fax

(503) 295-0731

NPI assigned

Jan 9, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Advanced Pain Management Center PCGroup PAC ID 0648169029, 3 clinicians

Uptown Providers PCGroup PAC ID 4284891243, 43 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dmitriy.shore.1@31950.direct.athenahealth.com

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.

• Uptown Providers PC

  • Urgent Care Clinic/Center
  • Tigard, OR
  • NPI 1346903531

  OR

  Medicare reassignment Care Compare group NPD (past)
• Advanced Pain Management Center PC

  • Pain Medicine Physician
  • Portland, OR
  • NPI 1760531339

  OR

  Medicare reassignment Care Compare group
• Uptown Providers PC

  • Urgent Care Clinic/Center
  • Vancouver, WA
  • NPI 1255102034
  Care Compare group NPD (past)
• Advanced Pain Management Center

  • Durable Medical Equipment & Medical Supplies
  • Portland, OR
  • NPI 1467773663
  NPD
• Uptown Providers PC

  • Urgent Care Clinic/Center
  • Vancouver, WA
  • NPI 1912702465
  NPD
• Uptown Providers PC

  • General Practice Physician
  • Portland, OR
  • NPI 1144598293
  NPD (past)

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124177902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10305 SW PARK WAY STE 300",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255033",
            "telephone_number": "503-295-0730",
            "fax_number": "503-295-0731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10305 SW PARK WAY STE 300",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255033",
            "telephone_number": "503-295-0730",
            "fax_number": "503-295-0731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHORE",
        "first_name": "DMITRIY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA00724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheryl Ann Shope
• Daniel Ryan Shor
• Katia Lease Shorb, FNP
• Amy M Shore, BS
• Cary M Shore, DNP-PMHNP
• Howard Everett Shore, PH.D, LPC
• Peter Shore, PSY.D.
• Rachel Shore, MD STUDENT
• Shore Shannon Shore
• Lisa Shorett, LMT

• All providers in Portland, OR
• Medical Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.