NPIMap

Organization Active NPI

Sportscare Physical Therapy @ Cornell, LLC

  • Durable Medical Equipment & Medical Supplies
  • Gresham, OR
National Provider Identifier
1609635507
Registry record updated Mar 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
SPORTSCARE PHYSICAL THERAPY @ CORNELL, LLC
Practice address
24076 SE Stark St Ste 210
Gresham, OR 97030-3376
Phone
(503) 491-1666
NPI assigned
Mar 14, 2024
Last updated
Mar 14, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2024

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

Authorized official

Name
Penny Tacker
Title
Regulatory Specialist
Phone
(713) 297-7052

Specialties & licenses 1

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

Addresses

Primary practice location

24076 SE Stark St Ste 210
Gresham, OR 97030-3376

Mailing address

24076 SE Stark St Ste 210
Gresham, OR 97030-3376
Phone (503) 491-1666

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240604003671 OR DME Supplier - Independently-Practicing Occupational Therapist 7517115579 Practice locations: Gresham, OR

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Sportscare Physical Therapy7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

NPI Registry JSON

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

{
    "created_epoch": "1710374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710374400000",
    "number": "1609635507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24076 SE STARK ST STE 210",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970303376",
            "telephone_number": "503-491-1666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24076 SE STARK ST STE 210",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970303376",
            "telephone_number": "503-491-1666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTSCARE PHYSICAL THERAPY @ CORNELL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-14",
        "last_updated": "2024-03-14",
        "certification_date": "2024-03-14",
        "status": "A",
        "authorized_official_last_name": "TACKER",
        "authorized_official_first_name": "PENNY",
        "authorized_official_title_or_position": "REGULATORY SPECIALIST",
        "authorized_official_telephone_number": "713-297-7052"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gresham, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2024; 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.