NPIMap

Organization Active NPI

Pacific Footwear Company, Inc.

Doing business as Priority Footwear & Pedorthic Services

  • Customized Equipment (DME)
  • Eugene, OR
National Provider Identifier
1427385343
Registry record updated Apr 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Customized Equipment (DME)Taxonomy code 332BC3200X
Legal business name
PACIFIC FOOTWEAR COMPANY, INC.
Doing business as
Priority Footwear & Pedorthic Services
Practice address
1142 Willagillespie Rd Ste 20
Eugene, OR 97401-6726
Phone
(541) 743-0620
Fax
(541) 743-0019
NPI assigned
Nov 13, 2009
Last updated
Apr 22, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2025

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

Authorized official

Name
Mr. Kevin Clarke
Title
President
Phone
(503) 524-9656

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Customized Equipment (DME) 332BC3200X Primary
Prosthetic/Orthotic Supplier 335E00000X

Addresses

Primary practice location

1142 Willagillespie Rd Ste 20
Eugene, OR 97401-6726

Mailing address

10240 SW Nimbus Ave
Suite L1
Portland, OR 97223-4358
Phone (503) 524-9656

Other identifiers 1

IdentifierTypeStateIssuer
297988MedicaidOR

Other names 1

  • Priority Footwear & Pedorthic Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930074622 OR DME Supplier - Medical Supply Company With Pedorthic PersonnelDME Supplier - Orthotic PersonnelDME Supplier - Pedorthic Personnel 5294936407 Practice locations: Eugene, OR

Other NPIs with the same Medicare PAC ID 3

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Priority Footwear & Pedorthic Servi1142 Willagillespie Rd, Eugene, OR 97401-6726(541) 743-0620 Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom Accepts assignmentParticipating since Jan 1, 2006

National Provider Directory

National Provider Directory
Tax ID family
Pacific Footwear Company Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

1142 Willagillespie Rd
Ste 23
Eugene, OR 97401

1142 Willagillespie Rd
Ste 20
Eugene, OR 97401
Phone (541) 343-1091

NPI Registry JSON

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

{
    "created_epoch": "1258070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745280000000",
    "number": "1427385343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10240 SW NIMBUS AVE",
            "address_2": "SUITE L1",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972234358",
            "telephone_number": "503-524-9656",
            "fax_number": "503-524-8397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1142 WILLAGILLESPIE RD STE 20",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974016726",
            "telephone_number": "541-743-0620",
            "fax_number": "541-743-0019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC FOOTWEAR COMPANY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-13",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-524-9656",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "297988",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Priority Footwear & Pedorthic Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eugene, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2025; 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.