Oregon Sports Medicine Associates

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

Legal business name

OREGON SPORTS MEDICINE ASSOCIATES

Practice address

29345 SW Town Center Loop E
Suite 211
Wilsonville, OR 97070-8486

Phone

(503) 692-8700

NPI assigned

Mar 19, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Jonathan Greenleaf, M.D.

Title

President

Phone

(503) 692-8700

Specialties & licenses 1

Addresses

Other names 1

• Sports Medicine Oregon Doing business as

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Oregon Sports Medicine Associates

  • Specialist
  • Tigard, OR
  • NPI 1093713729

  Member Of

  NPD member

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Dmitriy Viktorovich Vakulchik, PA

  • Physician Assistant
  • Tigard, OR
  • NPI 1841144805
  NPD (past)

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

{
    "created_epoch": "1332115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334793600000",
    "number": "1487929741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7300 SW CHILDS RD",
            "address_2": "SUITE B",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247772",
            "telephone_number": "503-692-8700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29345 SW TOWN CENTER LOOP E",
            "address_2": "SUITE 211",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970708486",
            "telephone_number": "503-692-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OREGON SPORTS MEDICINE ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-19",
        "last_updated": "2012-04-19",
        "status": "A",
        "authorized_official_last_name": "GREENLEAF",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-692-8700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sports Medicine Oregon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jane Christine Olyaei, BSPHARM
• Oregon Compounding Centers, Inc.
• Oregon CVS Pharmacy LLC
• Oregon Department of Corrections
• Oregon Regeneration Stem Cell Medical Center, LLC
• Emmalyn Grace Pangindian Ortiz, PT, DPT
• Kathryn Mary Overby, LMT
• Krystin Brackett Overstreet, CCC-SLP
• Karen Darlene Owens, P.T.
• Pacific Eye Group, PC

• Orthopaedic Surgery Physician in Wilsonville, OR
• Providers in Wilsonville, OR by specialty
• Orthopaedic Surgery Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.