Ty A Bommersbach, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

62978 Issued in OR

Practice address

2695 SW Cedar Hills Blvd Ste 140
Beaverton, OR 97005-1415

Phone

(503) 850-9950

Fax

(866) 252-2247

NPI assigned

Dec 29, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Go to Ortho, LLCGroup PAC ID 9537575543, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Go to Ortho LLC

  dba The Injury Clinic

  • Orthopedic Physical Therapist
  • Lake Oswego, OR
  • NPI 1083206155
  Medicare reassignment Care Compare group NPD
• Summit Orthopaedics, LLP

  • Orthopaedic Surgery Physician
  • Lake Oswego, OR
  • NPI 1427200021
  Medicare reassignment NPD (past)

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

{
    "created_epoch": "1482969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623801600000",
    "number": "1346785326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 SW CEDAR HILLS BLVD STE 140",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970051415",
            "telephone_number": "503-850-9950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2695 SW CEDAR HILLS BLVD STE 140",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970051415",
            "telephone_number": "503-850-9950",
            "fax_number": "866-252-2247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOMMERSBACH",
        "first_name": "TY",
        "middle_name": "A",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-12-29",
        "last_updated": "2021-06-16",
        "certification_date": "2021-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "62978",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua D Bogart
• Anna Aleksandrovna Boglayeva, RPH
• Joel Ivan Bohling, MD
• Bold Pediatric Therapy Center Inc
• Rachel Elizabeth Boll
• Robin Ann Bonanomi, M.S.
• Alexandra Gabrielle Bond, M.D.
• Laura Bonin
• Espree Elizabeth Bonterre, L.M.T.
• Gabriella Bordonali

• Physical Therapist in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2021; 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.