Nicholas D Hagen, DPT, SCS, CSCS

Primary specialty

Sports Physical TherapistTaxonomy code 2251S0007X

License

6856 Issued in OR

Practice address

1160 SW Simpson Ave
Ste 200
Bend, OR 97702

Phone

(541) 322-9045

Fax

(541) 322-9044

NPI assigned

Dec 7, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Erhardt Physical Therapy and Sports Medicine, LLC

  • Physical Therapist
  • Scappoose, OR
  • NPI 1326110313
  NPD (past)

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

{
    "created_epoch": "1260144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456963200000",
    "number": "1609104496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 SW INDUSTRIAL WAY",
            "address_2": "STE 3",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021093",
            "telephone_number": "541-585-2529",
            "fax_number": "541-585-2536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 SW SIMPSON AVE",
            "address_2": "STE 200",
            "city": "BEND",
            "state": "OR",
            "postal_code": "97702",
            "telephone_number": "541-322-9045",
            "fax_number": "541-322-9044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGEN",
        "first_name": "NICHOLAS",
        "middle_name": "D",
        "credential": "DPT, SCS, CSCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-12-07",
        "last_updated": "2016-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "OR",
            "license": "6856",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500695874",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Haefele, MSW, LCSW
• Danielle R Hafner, MD
• Hagen Psychiatry LLC
• Bryan M Hagen, DNP, PMHNP
• Lindsey E Hagen, PT
• Daniel Stuart Hagg, MD
• Haggen Opco North LLC
• Lindsay Hagler, ATC
• Dave A Haglund
• Kenneth Alan Hahn, MD

• Sports Physical Therapist in Bend, OR
• Providers in Bend, OR by specialty
• Sports Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2016; 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.