Active Recovery TMS LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

ACTIVE RECOVERY TMS LLC

Practice address

4949 Meadows Rd Ste 250
Lake Oswego, OR 97035-3147

Phone

(503) 708-9901

NPI assigned

Nov 20, 2020

Organization subpart

No

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

Authorized official

Name

Mr. David Grano

Title

Ceo

Phone

(503) 708-9901

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1605830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605830400000",
    "number": "1740883602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4949 MEADOWS RD STE 250",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970353147",
            "telephone_number": "503-708-9901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4949 MEADOWS RD STE 250",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970353147",
            "telephone_number": "503-708-9901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE RECOVERY TMS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-20",
        "last_updated": "2020-11-20",
        "certification_date": "2020-11-20",
        "status": "A",
        "authorized_official_last_name": "GRANO",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "503-708-9901",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMERCIAL INSURANCE",
            "identifier": "2084P0800X",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2084P0800X",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Lake Oswego, OR
• Providers in Lake Oswego, OR by specialty
• Psychiatry Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.