NPIMap

Organization Active NPI

Willamette Orthotics & Prosthetics LLC

Doing business as Summit Orthotics and Prosthetics

  • Prosthetic/Orthotic Supplier
  • Tualatin, OR
National Provider Identifier
1124726815
Registry record updated Sep 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
WILLAMETTE ORTHOTICS & PROSTHETICS LLC
Doing business as
Summit Orthotics and Prosthetics
Practice address
19767 SW 72ND Ave Ste 102
Tualatin, OR 97062-8354
Phone
(503) 364-6006
Fax
(503) 364-6046
NPI assigned
Feb 21, 2023
Last updated
Sep 17, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
WILLAMETTE ORTHOTICS & PROSTHETICS LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 17, 2026

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

Authorized official

Name
Ivan Sabel
Title
Ceo
Phone
(503) 364-6006

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Prosthetic/Orthotic Supplier 335E00000X Primary

Addresses

Primary practice location

19767 SW 72ND Ave Ste 102
Tualatin, OR 97062-8354

Mailing address

PO Box 7339
Salem, OR 97303-0102
Phone (503) 364-6006

Other names 1

  • SUMMIT ORTHOTICS AND PROSTHETICS Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240710001022 OR DME Supplier - Certified Orth/Pros/Pedorthist 5092826503 Practice locations: Tualatin, OR

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Willamette Orthotics and Prosthetic19767 SW 72ND Ave, Tualatin, OR 97062-8354(503) 451-5919 Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom|Lymphedema Compression Treatment Items Accepts assignmentParticipating since Jan 1, 2006

National Provider Directory

National Provider Directory
Tax ID family
Willamette Orthotics Prosthetics LLC9 organizations share this tax ID, including this one
Part of
Willamette Orthotics Prosthetics LLC

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2200 NE Neff Rd
Ste 307
Bend, OR 97701
Phone (541) 389-5422

2851 NW 9th St
Ste A
Corvallis, OR 97330
Phone (541) 738-2462

350 NW Elks Dr
Ste 201
Corvallis, OR 97330
Phone (541) 738-2462

1800 Coburg Rd
Ste B
Eugene, OR 97401
Phone (541) 743-0612

935 Willagillespie Rd
Ste B
Eugene, OR 97401
Phone (541) 431-7377

375 SE Norton Ln
Ste D
McMinnville, OR 97128
Phone (503) 474-4434

111 NW Larch Ave
Ste 100
Redmond, OR 97756
Phone (503) 923-2552

NPI Registry JSON

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

{
    "created_epoch": "1676937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789603200000",
    "number": "1124726815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7339",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973030102",
            "telephone_number": "503-364-6006",
            "fax_number": "503-364-6046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19767 SW 72ND AVE STE 102",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970628354",
            "telephone_number": "503-364-6006",
            "fax_number": "503-364-6046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLAMETTE ORTHOTICS & PROSTHETICS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILLAMETTE ORTHOTICS & PROSTHETICS LLC",
        "enumeration_date": "2023-02-21",
        "last_updated": "2026-09-17",
        "certification_date": "2026-09-17",
        "status": "A",
        "authorized_official_last_name": "SABEL",
        "authorized_official_first_name": "IVAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "503-364-6006"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SUMMIT ORTHOTICS AND PROSTHETICS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tualatin, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2026; 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.