NPIMap

Organization Active NPI

Premere Rehab LLC

  • Physical Therapist
  • Lake Oswego, OR
National Provider Identifier
1467767269
Registry record updated Jan 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PREMERE REHAB LLC
Practice address
1200 Overlook Dr
Lake Oswego, OR 97034-6605
Phone
(503) 496-3755
Fax
(503) 638-4980
NPI assigned
Aug 17, 2010
Last updated
Jan 2, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2013

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

Authorized official

Name
Laura A Cantrell, PTNPI 1588855126
Title
Director of Outpatient
Phone
(360) 901-8111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary
Occupational Therapist 225X00000X
Speech-Language Pathologist 235Z00000X

Addresses

Primary practice location

1200 Overlook Dr
Lake Oswego, OR 97034-6605

Mailing address

25117 SW Parkway Ave
Suite D
Wilsonville, OR 97070-9697

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110105000915 OR Part B Supplier - Clinic/Group Practice 2567434764 Receives reassigned benefits from 36 practitioners
28 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Eugene, OR; Happy Valley, OR; Hillsboro, OR; Lake Oswego, OR; Medford, OR; Milwaukie, OR; Newberg, OR; Salem, OR…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467767269. Details of each certification follow.

  • CCN 386543 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 386543

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
INFINITY REHAB
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Jun 6, 2014
Last certification
May 22, 2014
Ownership / control type
Proprietary
Facility address
1200 Overlook Dr
Lake Oswego, OR 97034

Other NPIs on the same Medicare enrollment 28

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 28

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1282003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357084800000",
    "number": "1467767269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25117 SW PARKWAY AVE",
            "address_2": "SUITE D",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970709697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 OVERLOOK DR",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970346605",
            "telephone_number": "503-496-3755",
            "fax_number": "503-638-4980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMERE REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-17",
        "last_updated": "2013-01-02",
        "status": "A",
        "authorized_official_last_name": "CANTRELL",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR OF OUTPATIENT",
        "authorized_official_telephone_number": "360-901-8111",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Oswego, OR

Sources for this page

Verify at the official NPI Registry.