NPIMap

Organization Active NPI

Spectrum Prosthetics and Orthotics, LLC

  • Prosthetic/Orthotic Supplier
  • Grants Pass, OR
National Provider Identifier
1265554984
Registry record updated Sep 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
License
NA
Legal business name
SPECTRUM PROSTHETICS AND ORTHOTICS, LLC
Practice address
300 Union Ave Ste C
Grants Pass, OR 97527-5861
Phone
(541) 955-9678
Fax
(541) 471-4909
NPI assigned
Apr 4, 2007
Organization subpart
Yes
Parent organization
ORTHO DEV AMERICA CORPAs 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
(541) 734-2435

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Customized Equipment (DME) 332BC3200X
Prosthetic/Orthotic Supplier 335E00000X NA Primary

Addresses

Primary practice location

300 Union Ave Ste C
Grants Pass, OR 97527-5861

Mailing address

300 Union Ave
Suite C
Grants Pass, OR 97527-5861
Phone (541) 955-9678

Other identifiers 1

IdentifierTypeStateIssuer
500637334MedicaidOR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110801000056 OR DME Supplier - Medical Supply Company With Orthotic-ProstheticDME Supplier - Pedorthic Personnel 9133397516 Practice locations: Grants Pass, OR

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Spectrum Prosthetics and Orthotics LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

300 Union Ave
Ste C
Grants Pass, OR 97527
Phone (541) 955-9678

NPI Registry JSON

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789603200000",
    "number": "1265554984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 UNION AVE",
            "address_2": "SUITE C",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975275861",
            "telephone_number": "541-955-9678",
            "fax_number": "541-471-4909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 UNION AVE STE C",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975275861",
            "telephone_number": "541-955-9678",
            "fax_number": "541-471-4909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM PROSTHETICS AND ORTHOTICS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ORTHO DEV AMERICA CORP",
        "enumeration_date": "2007-04-04",
        "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": "541-734-2435"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": "NA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500637334",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grants Pass, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.