Charles Justin Petit, M.D.

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

License

MD29397 Issued in OR

Practice address

17355 Lower Boones Ferry Rd
#100A
Lake Oswego, OR 97035-2839

Phone

(503) 224-8399

Fax

(503) 224-5661

NPI assigned

Nov 3, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Sports MedicineAlso: Orthopedic Surgery

Education

University of California, San Diego School of Medicine, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Orthopedic and Sports Medicine Center of Oregon LLCGroup PAC ID 3678537602, 16 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Legacy Good Samaritan Medical Center Hospital, Portland, OR, CCN 380017
• Providence Portland Medical Center Hospital, Portland, OR, CCN 380061
• Skyline Hospital Hospital, White Salmon, WA, CCN 501315
• Providence Hood River Memorial Hospital Hospital, Hood River, OR, CCN 381318
• Mid-Columbia Medical Center Hospital, The Dalles, OR, CCN 380001

Merit-based Incentive Payment System (MIPS)

Final score

28.52 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

95.05

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Orthopedic & Sports Medicine Center of Oregon LLC

  • Orthopaedic Surgery Physician
  • Lake Oswego, OR
  • NPI 1891734877
  Medicare reassignment Care Compare group NPD
• Orthopedic & Sports Medicine Center of Or LLC

  • Orthopaedic Surgery Physician
  • Scappoose, OR
  • NPI 1639596588
  NPD
• Frances Mahon Deaconess Hospital

  • Critical Access Hospital
  • Glasgow, MT
  • NPI 1689685323
  NPD (past)
• Steadman Clinic Professional LLC

  • Specialist
  • Vail, CO
  • NPI 1952327835

  Orthopaedic Surgery

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Legacy Good Samaritan Hospital and Medical Center

  • Clinic/Center
  • Portland, OR
  • NPI 1679597108

  Hospital

  Care Compare affiliation
• Legacy Good Samaritan Hospital and Medical Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1780608216
  Care Compare affiliation
• Mid-Columbia Medical Center

  • Critical Access Hospital Clinic/Center
  • The Dalles, OR
  • NPI 1306842752
  Care Compare affiliation
• Providence Health & Services - Oregon

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1003991845
  Care Compare affiliation
• Providence Health & Services - Oregon

  • Case Manager/Care Coordinator
  • Portland, OR
  • NPI 1891822995

  Hospital

  Care Compare affiliation
• Providence Health & Services Oregon

  • Critical Access Hospital
  • Hood River, OR
  • NPI 1255429338
  Care Compare affiliation
• Public Hospital District No. 2, Klickitat County, Washington

  • Critical Access Hospital
  • White Salmon, WA
  • NPI 1760455687
  Care Compare affiliation

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

{
    "created_epoch": "1130976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756080000000",
    "number": "1356332720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17355 LOWER BOONES FERRY RD",
            "address_2": "#100A",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970352839",
            "telephone_number": "503-224-8399",
            "fax_number": "503-224-5661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17355 LOWER BOONES FERRY RD",
            "address_2": "#100A",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970352839",
            "telephone_number": "503-224-8399",
            "fax_number": "503-224-5661"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5050 NE Hoyt St Ste 668",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972132990",
            "country_code": "US",
            "telephone_number": "503-224-8399",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETIT",
        "first_name": "CHARLES",
        "middle_name": "JUSTIN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-03",
        "last_updated": "2025-08-25",
        "certification_date": "2025-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "OR",
            "license": "MD29397",
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "OR",
            "license": "MD29397",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dylann Perrone
• Carly Christoferson Petersen, DMD
• Peterson Orthodontics & Periodontics, LLC
• Larry Len Peterson, M.D.
• Noel S. Peterson, N.D.
• Mark A. Petroff, M.D.
• Amalia Margaret Iwasaki Pfeifer, PT
• Tuan Ngoc Pham
• Vickie T. Pham, FNP
• Nina Pherigo, NP

• Sports Medicine (Orthopaedic Surgery) Physician in Lake Oswego, OR
• Providers in Lake Oswego, OR by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.