Individual provider Active NPI

Todd Jason Cruz, PT

  • Physical Therapist
  • Portland, OR
National Provider Identifier
1366424228
Registry record updated Nov 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
3020 Issued in OR
Practice address
2701 NW Vaughn St
Ste 155
Portland, OR 97210-5311
Phone
(503) 227-3479
Fax
(503) 223-4838
NPI assigned
Nov 16, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 3020 OR Primary

Addresses

Primary practice location

2701 NW Vaughn St
Ste 155
Portland, OR 97210-5311

Mailing address

16083 SW Upper Boones Ferry Rd
Ste 300
Tigard, OR 97224-7736
Phone (800) 219-8835

Other identifiers 1

IdentifierTypeStateIssuer
295703MedicaidOR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110504000465 OR Practitioner - Physical Therapist in Private Practice 5193815744 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Therapeutic Associates IncGroup PAC ID 0042116279, 319 clinicians

Practice addresses (Care Compare)

20055 SW Pacific Hwy
Suite 110
Sherwood, OR 97140-9294
Phone (503) 625-1691

818 NW 14TH Ave
Portland, OR 97209-2703
Phone (503) 227-3479

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3020ORMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Therapeutic Associates Inc Physical Therapist Current Accepting new patients
Therapeutic Associates Inc Physical Therapist CurrentSince Sep 1, 2001 Accepting new patients
Therapeutic Associates Inc Physical Therapist CurrentSince Sep 1, 2001 Accepting new patients
Therapeutic Associates Inc Physical Therapist Past Accepting new patients
Therapeutic Associates Inc Physical Therapist Past Accepting new patients

Locations

2701 NW Vaughn St
Ste 155
Portland, OR 97210
Phone (503) 227-3479

10215 SW Parkway
Ste D
Portland, OR 97225
Phone (503) 292-3583

20055 SW Pacific Hwy
Ste 110
Sherwood, OR 97140
Phone (503) 625-1691

16083 SW Upper Boones Ferry Rd
Ste 300
Tigard, OR 97224
Phone (503) 443-6153

Interoperability endpoints

  • Direct secure messaging: todd.cruz.1@31414.direct.athenahealth.com

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351728000000",
    "number": "1366424228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16083 SW UPPER BOONES FERRY RD",
            "address_2": "STE 300",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247736",
            "telephone_number": "800-219-8835",
            "fax_number": "503-639-9699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 NW VAUGHN ST",
            "address_2": "STE 155",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972105311",
            "telephone_number": "503-227-3479",
            "fax_number": "503-223-4838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUZ",
        "first_name": "TODD",
        "middle_name": "JASON",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-16",
        "last_updated": "2012-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "3020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "295703",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2012; 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.