NPIMap

Organization Active NPI

Eastside Orthopedics & Sports Medicine, LLC

  • Orthopaedic Surgery Physician
  • Clackamas, OR
National Provider Identifier
1225567928
Registry record updated Jun 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
EASTSIDE ORTHOPEDICS & SPORTS MEDICINE, LLC
Practice address
10121 SE Sunnyside Rd Ste 100
Clackamas, OR 97015-5755
Phone
(503) 659-1769
Fax
(503) 659-7522
NPI assigned
Jun 6, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2026

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

Authorized official

Name
Paul D Ruesch, MDNPI 1558393876
Title
MD/ Physician
Phone
(503) 659-1964

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X Primary
Orthopaedic Foot and Ankle Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XX0004X MD183085 OR

Addresses

Primary practice location

10121 SE Sunnyside Rd Ste 100
Clackamas, OR 97015-5755

Mailing address

10121 SE Sunnyside Rd Ste 100
Clackamas, OR 97015-5755
Phone (503) 659-1769

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170920002002 OR Part B Supplier - Clinic/Group Practice 7113177353 Receives reassigned benefits from 6 practitioners
Practice locations: Gresham, OR; Milwaukie, OR

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

24900 SE Stark St
Ste 208
Gresham, OR 97030
Phone (503) 666-3030

Practitioners & affiliated clinicians

Practitioners 7

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": "1496707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782777600000",
    "number": "1225567928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10121 SE SUNNYSIDE RD STE 100",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970155755",
            "telephone_number": "503-659-1769",
            "fax_number": "503-659-7522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10121 SE SUNNYSIDE RD STE 100",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970155755",
            "telephone_number": "503-659-1769",
            "fax_number": "503-659-7522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE ORTHOPEDICS & SPORTS MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-06",
        "last_updated": "2026-06-30",
        "certification_date": "2026-06-30",
        "status": "A",
        "authorized_official_last_name": "RUESCH",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MD/ PHYSICIAN",
        "authorized_official_telephone_number": "503-659-1964",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207XX0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Foot and Ankle Surgery",
            "state": "OR",
            "license": "MD183085",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clackamas, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2026; 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.