Portland Orthopedic Services P.C.

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

Legal business name

PORTLAND ORTHOPEDIC SERVICES P.C.

Practice address

12037 NE Marx St
Portland, OR 97220-9013

Phone

(503) 408-8378

Fax

(503) 408-8389

NPI assigned

Jun 30, 2006

Organization subpart

No

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

Authorized official

Name

Mr. William Wallace Tilson, C.O.

Title

Owner/President

Phone

(503) 408-8378

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

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

Locations

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1467480053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12037 NE MARX ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972209013",
            "telephone_number": "503-408-8378",
            "fax_number": "503-408-8389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12037 NE MARX ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972209013",
            "telephone_number": "503-408-8378",
            "fax_number": "503-408-8389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTLAND ORTHOPEDIC SERVICES P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TILSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "WALLACE",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "503-408-8378",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "C.O."
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "230829",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Portland Opportunities Industrialization Center, Inc.
• Portland Oral and Facial Surgery
• Portland Ortho Pain & Spine LLC
• Portland Orthodontic Group (Yaillen Orthodontic Group)
• Portland Orthodontic Group, LLC
• Portland Orthopedic Surgery Center LLC
• Portland Otologic Clinic PC (John M Epley MD)
• Portland Pain Medicine LLC
• Portland Pediatric Acupuncture
• Portland Pediatric Nutrition

• Customized Equipment (DME) in Portland, OR
• Providers in Portland, OR by specialty
• Customized Equipment (DME) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.