Individual provider Active NPI

Jonathan Kevin Cruz, DC

  • Chiropractor
  • Lake Oswego, OR
National Provider Identifier
1437930963
Registry record updated Nov 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
6335 Issued in OR
Practice address
4847 Meadows Rd Ste 153
Lake Oswego, OR 97035-2626
Phone
(971) 330-8578
NPI assigned
Oct 10, 2023
Last updated
Nov 28, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 6335 OR Primary

Addresses

Primary practice location

4847 Meadows Rd Ste 153
Lake Oswego, OR 97035-2626

Mailing address

1905 Main St Apt 302
Oregon City, OR 97045-1074
Phone (541) 232-6479

Other practice location 1

1905 Main St Apt 302
Oregon City, OR 97045-1074
Phone (541) 232-6479

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240301002315 OR Practitioner - Chiropractic 2062857980 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2023
Medicare assignment
May accept Medicare assignment
Group practices
Asula Chiropractic and Wellness Center, Inc.Group PAC ID 0244407617, 8 clinicians

Practice addresses (Care Compare)

4847 Meadows Rd
Suite 153
Lake Oswego, OR 97035-2626
Phone (971) 330-8578

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6335ORMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Asula Chiropractic and Wellness Center, Inc. Chiropractor CurrentSince Jan 3, 2024 Accepting new patients

Locations

4847 Meadows Rd
Ste 153
Lake Oswego, OR 97035
Phone (971) 330-8578

818 NW Marshall St
Portland, OR 97209
Phone (503) 719-5335

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1696896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701129600000",
    "number": "1437930963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 MAIN ST APT 302",
            "city": "OREGON CITY",
            "state": "OR",
            "postal_code": "970451074",
            "telephone_number": "541-232-6479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4847 MEADOWS RD STE 153",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970352626",
            "telephone_number": "971-330-8578"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1905 Main St Apt 302",
            "address_purpose": "LOCATION",
            "city": "Oregon City",
            "state": "OR",
            "postal_code": "970451074",
            "country_code": "US",
            "telephone_number": "541-232-6479",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CRUZ",
        "first_name": "JONATHAN",
        "middle_name": "KEVIN",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-10-10",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "6335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Oswego, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2023; 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.