NPIMap

Organization Active NPI

Northwest Surgical Specialists PC

  • Durable Medical Equipment & Medical Supplies
  • Lake Oswego, OR
National Provider Identifier
1609398239
Registry record updated Jul 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
NORTHWEST SURGICAL SPECIALISTS PC
Practice address
4811 Meadows Rd Ste 101
Lake Oswego, OR 97035-2542
Phone
(360) 254-6161
NPI assigned
Jul 14, 2017
Organization subpart
Yes
Parent organization
NORTHWEST SURGICAL SPECIALISTS PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 14, 2017

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

Authorized official

Name
Jay L Crary, MD
Title
Authorized Official
Phone
(360) 254-6161

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

4811 Meadows Rd Ste 101
Lake Oswego, OR 97035-2542

Mailing address

200 NE Mother Joseph PL Ste 210
Vancouver, WA 98664-3295
Phone (360) 254-6161

Other names 1

  • Rebound Orthopedics Lake Oswego Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170926002714 OR DME Supplier - Physician - Orthopedic/Orthopedic Surgery 4183527153 Practice locations: Lake Oswego, OR

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D2136696Northwest Surgical Specialists, PC4811 SW Meadows Rd Suite 101, Lake Oswego, OR 97035Certificate of waiverSep 12, 2027

National Provider Directory

National Provider Directory
Tax ID family
NW Surgical Specialists5 organizations share this tax ID, including this one
Part of
NW Surgical Specialists

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1499990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1499990400000",
    "number": "1609398239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 NE MOTHER JOSEPH PL STE 210",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986643295",
            "telephone_number": "360-254-6161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4811 MEADOWS RD STE 101",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970352542",
            "telephone_number": "360-254-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST SURGICAL SPECIALISTS PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHWEST SURGICAL SPECIALISTS PC",
        "enumeration_date": "2017-07-14",
        "last_updated": "2017-07-14",
        "status": "A",
        "authorized_official_last_name": "CRARY",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "360-254-6161",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rebound Orthopedics Lake Oswego",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lake Oswego, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2017; 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.