NPIMap

Organization Active NPI

R Tyson Scott DPM LLC

  • Podiatric Clinic/Center
  • Salem, OR
National Provider Identifier
1659638872
Registry record updated Sep 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Podiatric Clinic/CenterTaxonomy code 261QP1100X
License
DP154513 Issued in OR
Legal business name
R TYSON SCOTT DPM LLC
Practice address
800 Liberty St SE
Salem, OR 97302
Phone
(503) 370-8784
NPI assigned
Apr 12, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2020

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

Authorized official

Name
Robert Tyson Scott, DPMNPI 1497918585
Title
Owner
Phone
(503) 370-8784

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
Podiatric Clinic/Center 261QP1100X DP154513 OR Primary

Addresses

Primary practice location

800 Liberty St SE
Salem, OR 97302

Mailing address

800 Liberty St SE
Salem, OR 97302-4137
Phone (503) 370-8784

Other practice location 1

350 Miller St SE
Salem, OR 97302-4272
Phone (503) 370-8784 ext. 103

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120620000539 OR Part B Supplier - Clinic/Group Practice 1759545858 Receives reassigned benefits from 2 practitioners
Practice locations: Dallas, OR; Salem, OR
O20120927000708 OR DME Supplier - Physician - General Surgery 1759545858 Practice locations: Salem, OR

National Provider Directory

National Provider Directory
Tax ID family
R Tyson Scott DPM LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

350 Miller St SE
Salem, OR 97302
Phone (503) 370-8784

890 Oak St SE
Salem, OR 97301
Phone (503) 585-0830

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1334188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600300800000",
    "number": "1659638872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 LIBERTY ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024137",
            "telephone_number": "503-370-8784",
            "fax_number": "503-362-4017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 LIBERTY ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "97302",
            "telephone_number": "503-370-8784"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "350 Miller St SE",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OR",
            "postal_code": "973024272",
            "country_code": "US",
            "telephone_number": "503-370-8784 x103",
            "fax_number": "503-362-4017",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "R TYSON SCOTT DPM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-12",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A",
        "authorized_official_last_name": "SCOTT",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "TYSON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-370-8784",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": "OR",
            "license": "DP154513",
            "primary": true
        }
    ],
    "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 Sep 17, 2020; 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.