Individual provider Active NPI

Bryan A Pasternak, MPT

  • Orthopedic Physical Therapist
  • Tigard, OR
National Provider Identifier
1669612115
Registry record updated Dec 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
3726 Issued in OR
Practice address
14880 SW Sunrise LN
Tigard, OR 97224-1255
Phone
(503) 496-0385
Fax
(866) 631-9368
NPI assigned
Feb 24, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X 3726 OR Primary
Geriatric Physical Therapist 2251G0304X 3726 OR

Addresses

Primary practice location

14880 SW Sunrise LN
Tigard, OR 97224-1255

Mailing address

PO Box 22499
Milwaukie, OR 97269-2499
Phone (503) 496-0385

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090421000718 OR Practitioner - Physical Therapist in Private Practice 9234286659 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3726ORMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Beyond the Clinic PC CurrentSince Apr 1, 2009 Accepting new patients

Locations

10600 SE McLoughlin Blvd
Ste 202
Portland, OR 97222
Phone (503) 496-0385

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1235433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701907200000",
    "number": "1669612115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22499",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972692499",
            "telephone_number": "503-496-0385",
            "fax_number": "866-633-1936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14880 SW SUNRISE LN",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972241255",
            "telephone_number": "503-496-0385",
            "fax_number": "866-631-9368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PASTERNAK",
        "first_name": "BRYAN",
        "middle_name": "A",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-24",
        "last_updated": "2023-12-07",
        "certification_date": "2023-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "OR",
            "license": "3726",
            "primary": true
        },
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "OR",
            "license": "3726",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tigard, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2023; 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.