NPIMap

Organization Active NPI

Oregon Institute of Foot Care LLC

  • Podiatrist
  • Lake Oswego, OR
National Provider Identifier
1124783345
Registry record updated Mar 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
OREGON INSTITUTE OF FOOT CARE LLC
Practice address
55 S State St Ste 3220
Lake Oswego, OR 97034-3975
Phone
(503) 635-7742
NPI assigned
Nov 2, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2022

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

Authorized official

Name
Dr. Tyler Manson, DPMNPI 1679833131
Title
Podiatric Physician
Phone
(503) 635-7742

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213E00000X Primary
Primary Podiatric Medicine PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213EP1101X
Radiology PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ER0200X
Sports Medicine PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0000X
Foot Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0131X

Addresses

Primary practice location

55 S State St Ste 3220
Lake Oswego, OR 97034-3975

Mailing address

55 S State St Ste 3220
Lake Oswego, OR 97034-3975
Phone (503) 635-7742

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211228002045 OR Part B Supplier - Clinic/Group Practice 0143611244 Receives reassigned benefits from 1 practitioner
Practice locations: Lake Oswego, OR

National Provider Directory

National Provider Directory

Locations

27 S State St
Ste 3220
Lake Oswego, OR 97034
Phone (503) 635-7742

Practitioners & affiliated clinicians

Practitioners 3

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": "1635811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648080000000",
    "number": "1124783345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 S STATE ST STE 3220",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970343975",
            "telephone_number": "503-635-7742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 S STATE ST STE 3220",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970343975",
            "telephone_number": "503-635-7742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OREGON INSTITUTE OF FOOT CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-02",
        "last_updated": "2022-03-24",
        "certification_date": "2021-11-16",
        "status": "A",
        "authorized_official_last_name": "MANSON",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "PODIATRIC PHYSICIAN",
        "authorized_official_telephone_number": "503-635-7742",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213EP1101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ER0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Oswego, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2022; 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.