Active NPI
Premere Rehab LLC
- Physical Therapist
- Beaverton, OR
National Provider Identifier
1689373201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Legal business name
- PREMERE REHAB LLC
- Practice address
- 14570 SW Hart Rd
Beaverton, OR 97007-7000 - Phone
- (503) 626-5100
- Fax
- (503) 526-3803
- NPI assigned
- Mar 2, 2023
- Organization subpart
- Yes
- Parent organization
- PREMERE REHAB LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Tammy McCoy
- Title
- Credentialing Specialist
- Phone
- (503) 496-5057
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary | ||
| Occupational Therapist | 225X00000X | |||
| Speech-Language Pathologist | 235Z00000X |
Addresses
Primary practice location
14570 SW Hart Rd
Beaverton, OR 97007-7000
Mailing address
8100 SW Nyberg St Ste 200
Tualatin, OR 97062-8437
Phone (503) 570-3665
Other names 1
- Infinity Rehab
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
Enrollment records 1
Other NPIs on the same Medicare enrollment 28
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Part of
- Sante of North Scottsdale
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Physical Rehabilitation Occupational Therapist
- Forest Grove, OR
- NPI 1578029369
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1677715200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1677715200000",
"number": "1689373201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8100 SW NYBERG ST STE 200",
"city": "TUALATIN",
"state": "OR",
"postal_code": "970628437",
"telephone_number": "503-570-3665",
"fax_number": "503-570-9155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14570 SW HART RD",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970077000",
"telephone_number": "503-626-5100",
"fax_number": "503-526-3803"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PREMERE REHAB LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PREMERE REHAB LLC",
"enumeration_date": "2023-03-02",
"last_updated": "2023-03-02",
"certification_date": "2023-03-02",
"status": "A",
"authorized_official_last_name": "MCCOY",
"authorized_official_first_name": "TAMMY",
"authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
"authorized_official_telephone_number": "503-496-5057"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
},
{
"code": "225X00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Occupational Therapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Speech-Language Pathologist",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Infinity Rehab",
"code": "3",
"type": "Doing Business As"
}
]
}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 Mar 2, 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.