Individual provider Active NPI

Cody Lommen, PT

  • Physical Therapist
  • Keizer, OR
National Provider Identifier
1134484603
Registry record updated Nov 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
6845 Issued in OR
Practice address
5955 Shoreview LN N
Ste. 100
Keizer, OR 97303-3981
Phone
(503) 463-4221
Fax
(503) 463-4522
NPI assigned
Jul 10, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 6845 OR Primary

Addresses

Primary practice location

5955 Shoreview LN N
Ste. 100
Keizer, OR 97303-3981

Mailing address

16083 SW Upper Boones Ferry Rd
Ste. 300
Tigard, OR 97224-7736
Phone (800) 219-8835

Other identifiers 1

IdentifierTypeStateIssuer
500647601MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121004000234 OR Practitioner - Physical Therapist in Private Practice 9537318977 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Therapeutic Associates IncGroup PAC ID 0042116279, 319 clinicians

Practice addresses (Care Compare)

5955 Shoreview LN N
Suite 100
Keizer, OR 97303-3988
Phone (503) 463-4221

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6845ORMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Therapeutic Associates Inc Physical Therapist CurrentSince Jul 10, 2012 Accepting new patients
Therapeutic Associates Inc Physical Therapist Current Accepting new patients
Therapeutic Associates Inc Physical Therapist CurrentSince Jul 10, 2012 Accepting new patients
Therapeutic Associates Inc Physical Therapist Past Accepting new patients
Therapeutic Associates Inc Physical Therapist Past Accepting new patients

Locations

5955 Shoreview Ln N
Ste 100
Keizer, OR 97303
Phone (503) 463-4221

16083 SW Upper Boones Ferry Rd
Ste 300
Tigard, OR 97224
Phone (503) 443-6153

Interoperability endpoints

  • Direct secure messaging: cody.lommen.1@31414.direct.athenahealth.com

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1341878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352419200000",
    "number": "1134484603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16083 SW UPPER BOONES FERRY RD",
            "address_2": "STE. 300",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247736",
            "telephone_number": "800-219-8835",
            "fax_number": "503-639-9699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5955 SHOREVIEW LN N",
            "address_2": "STE. 100",
            "city": "KEIZER",
            "state": "OR",
            "postal_code": "973033981",
            "telephone_number": "503-463-4221",
            "fax_number": "503-463-4522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOMMEN",
        "first_name": "CODY",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-10",
        "last_updated": "2012-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "6845",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500647601",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Keizer, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2012; 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.