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

Last updated

Jul 8, 2007By the provider in NPPES

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Advanced Pain Management Center PC

  • Pain Medicine Physician
  • Portland, OR
  • NPI 1760531339
  Medicare reassignment Care Compare group NPD
• Uptown Providers PC

  dba AFC Urgent Care

  • Urgent Care Clinic/Center
  • Tigard, OR
  • NPI 1346903531
  Medicare reassignment Care Compare group NPD (past)
• Uptown Providers PC

  • General Practice Physician
  • Beaverton, OR
  • NPI 1710349477
  NPD
• Uptown Providers PC

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

  dba AFC Urgent Care

  • Urgent Care Clinic/Center
  • Vancouver, WA
  • NPI 1255102034
  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": []
}

• Brettina Shoop
• Sheryl Ann Shope
• Daniel Ryan Shor
• Katia Lease Shorb, FNP
• 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

• Medical Physician Assistant in Portland, OR
• Providers in Portland, OR by specialty
• 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.