NPIMap

Organization Active NPI

Premere Rehab, LLC

  • Physical Therapist
  • Salem, OR
National Provider Identifier
1538401070
Registry record updated Mar 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PREMERE REHAB, LLC
Practice address
3411 Boone Rd SE
Salem, OR 97317-9336
Phone
(503) 480-0004
NPI assigned
Mar 22, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2013

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

Authorized official

Name
Laura 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 TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X

Addresses

Primary practice location

3411 Boone Rd SE
Salem, OR 97317-9336

Mailing address

25117 SW Parkway Ave
Suite D
Wilsonville, OR 97070-9697
Phone (971) 224-2037

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…

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

Locations

3411 Boone Rd SE
Salem, OR 97317
Phone (503) 480-0004

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": "1363910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363910400000",
    "number": "1538401070",
    "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",
            "telephone_number": "971-224-2037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3411 BOONE RD SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973179336",
            "telephone_number": "503-480-0004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMERE REHAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-22",
        "last_updated": "2013-03-22",
        "status": "A",
        "authorized_official_last_name": "CANTRELL",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "DIRECTOR OF OUTPATIENT",
        "authorized_official_telephone_number": "360-901-8111",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2013; 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.