Active NPI
Kevin Blaine Bingham, PTA
- Physical Therapy Assistant
- Sublimity, OR
National Provider Identifier
1679078331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 09469
- Practice address
- 390 SE Church St
Sublimity, OR 97385-9714 - Phone
- (801) 550-5329
- NPI assigned
- Mar 26, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 8177960-2402 | UT | |
| Physical Therapy Assistant | 225200000X | 09469 | OR | Primary |
Addresses
Primary practice location
390 SE Church St
Sublimity, OR 97385-9714
Mailing address
1036 Limelight Ave NW
Salem, OR 97304-3427
Phone (801) 550-5329
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 09469 | OR | MD | Physical Therapy Assistant |
| 8177960-2402 | UT | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522022400000",
"number": "1679078331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1036 LIMELIGHT AVE NW",
"city": "SALEM",
"state": "OR",
"postal_code": "973043427",
"telephone_number": "801-550-5329"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "390 SE CHURCH ST",
"city": "SUBLIMITY",
"state": "OR",
"postal_code": "973859714",
"telephone_number": "801-550-5329"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BINGHAM",
"first_name": "KEVIN",
"middle_name": "BLAINE",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-03-26",
"last_updated": "2018-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "UT",
"license": "8177960-2402",
"primary": false
},
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "OR",
"license": "09469",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sublimity, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.