Individual provider Active NPI

Heidi Lynn Tyson, OTR/L

  • Occupational Therapist
  • Tigard, OR
National Provider Identifier
1174798292
Registry record updated Dec 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
1035732 Issued in OR
Practice address
9250 SW Hall Blvd
Tigard, OR 97223-6721
Phone
(503) 293-0161
NPI assigned
Apr 29, 2008
Last updated
Dec 29, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 4605 NC
Occupational Therapist 225X00000X 1035732 OR Primary

Addresses

Primary practice location

9250 SW Hall Blvd
Tigard, OR 97223-6721

Mailing address

800 SW 13TH Ave
Portland, OR 97205-1902
Phone (503) 221-0161

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address htyson12812@direct.theportlandclinic.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20131227000292 OR Practitioner - Occupational Therapist in Private Practice 1658540521 Reassigns benefits to 1 organization
I20180801000541 TN Practitioner - Occupational Therapist in Private Practice 1658540521 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
University of South Alabama College of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Portland ClinicGroup PAC ID 8224942867, 93 clinicians

Practice addresses (Care Compare)

800 SW 13TH Ave
Portland, OR 97205-1902
Phone 50322101612110

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4605NCMDChiropractor
5763TNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Vanderbilt University Medical Center CurrentSince Apr 20, 2018 Accepting new patients
Portland Clinic CurrentSince May 1, 2020 Accepting new patients
Portland Clinic PastSince Jan 3, 2021 Accepting new patients
Iatros, Inc Past Accepting new patients

Locations

Dept A T 40379
Atlanta, GA 31192

800 SW 13th Ave
Portland, OR 97205
Phone (503) 221-0161

9250 SW Hall Blvd
Tigard, OR 97223
Phone (503) 221-0161

719 Thompson Ln
Nashville, TN 37204
Phone (615) 322-6485

719 Thompson Ln
Ste 30330
Nashville, TN 37204
Phone (615) 936-3871

Interoperability endpoints

  • Direct secure messaging: htyson12812@direct.theportlandclinic.net

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609200000000",
    "number": "1174798292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 SW 13TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972051902",
            "telephone_number": "503-221-0161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9250 SW HALL BLVD",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972236721",
            "telephone_number": "503-293-0161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYSON",
        "first_name": "HEIDI",
        "middle_name": "LYNN",
        "name_prefix": "Miss",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-29",
        "last_updated": "2020-12-29",
        "certification_date": "2020-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NC",
            "license": "4605",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "OR",
            "license": "1035732",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "htyson12812@direct.theportlandclinic.net",
            "affiliation": "N",
            "address_1": "9250 SW Hall Blvd",
            "city": "Tigard",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972236721",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tigard, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2020; 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.