NPIMap

Organization Active NPI

Sportscare Physical Therapy @ Cornell, LLC

  • Physical Therapy Clinic/Center
  • Beaverton, OR
National Provider Identifier
1649534793
Registry record updated Jul 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
1660 Issued in OR
Legal business name
SPORTSCARE PHYSICAL THERAPY @ CORNELL, LLC
Practice address
15390 NW Cornell Rd.
Suite 230
Beaverton, OR 97006
Phone
(503) 257-9881
NPI assigned
Jul 3, 2012
Last updated
Jul 3, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2012

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

Authorized official

Name
Joseph John Fricke, PTNPI 1851350870
Title
Managing Partner
Phone
(503) 257-9881

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 1660 OR Primary

Addresses

Primary practice location

15390 NW Cornell Rd.
Suite 230
Beaverton, OR 97006

Mailing address

15390 NW Cornell Rd.
Suite 230
Beaverton, OR 97006

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120917000315 OR Part B Supplier - Clinic/Group Practice 7517115579 Receives reassigned benefits from 43 practitioners
Practice locations: Tigard, OR; Sandy, OR; Salem, OR; Portland, OR; Clackamas, OR; Gresham, OR; Beaverton, 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 Therapy Cornell LLC7 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.

Locations

10121 SE Sunnyside Rd
Ste 208
Clackamas, OR 97015
Phone (503) 427-2956

Practitioners & affiliated clinicians

Practitioners 48

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.

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1341273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341273600000",
    "number": "1649534793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15390 NW CORNELL RD.",
            "address_2": "SUITE 230",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "97006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15390 NW CORNELL RD.",
            "address_2": "SUITE 230",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "97006",
            "telephone_number": "503-257-9881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTSCARE PHYSICAL THERAPY @ CORNELL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-03",
        "last_updated": "2012-07-03",
        "status": "A",
        "authorized_official_last_name": "FRICKE",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "503-257-9881",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "OR",
            "license": "1660",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaverton, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2012; 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.