NPIMap

Organization Active NPI

Pursuit Sports Medicine LLC

Doing business as Paul W Johnson, DO

  • Sports Medicine (Internal Medicine) Physician
  • Portland, OR
National Provider Identifier
1447705801
Registry record updated Oct 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0010X
License
DO28084 Issued in OR
Legal business name
PURSUIT SPORTS MEDICINE LLC
Doing business as
Paul W Johnson, DO
Practice address
2222 NW Lovejoy St
Ste 522
Portland, OR 97210-3033
Phone
(971) 302-7084
Fax
(503) 286-7939
NPI assigned
Aug 16, 2016
Last updated
Oct 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2024

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

Authorized official

Name
Paul W Johnson, DONPI 1689785925
Title
Owner
Phone
(971) 302-7084

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Internal Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RS0010X DO28084 OR Primary

Addresses

Primary practice location

2222 NW Lovejoy St
Ste 522
Portland, OR 97210-3033

Mailing address

3439 NE Sandy Blvd
#234
Portland, OR 97232-1959
Phone (971) 302-7084

Other names 1

  • Paul W Johnson, DO Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160928000824 OR Part B Supplier - Clinic/Group Practice 3274820691 Receives reassigned benefits from 1 practitioner
Practice locations: Portland, OR
O20241017002634 WA Part B Supplier - Clinic/Group Practice 3274820691 Receives reassigned benefits from 1 practitioner
Practice locations: Vancouver, WA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1471305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730246400000",
    "number": "1447705801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3439 NE SANDY BLVD",
            "address_2": "#234",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321959",
            "telephone_number": "971-302-7084",
            "fax_number": "503-286-7939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 NW LOVEJOY ST",
            "address_2": "STE 522",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972103033",
            "telephone_number": "971-302-7084",
            "fax_number": "503-286-7939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURSUIT SPORTS MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-16",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "971-302-7084",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207RS0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Sports Medicine",
            "state": "OR",
            "license": "DO28084",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Paul W Johnson, DO",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Oct 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.