NPIMap

Organization Active NPI

Restore Interventional Spine & Sports Medicine LLC

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Beaverton, OR
National Provider Identifier
1801139019
Registry record updated Oct 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
License
DO150752 Issued in OR
Legal business name
RESTORE INTERVENTIONAL SPINE & SPORTS MEDICINE LLC
Practice address
9925 SW Nimbus Ave
Suite 100
Beaverton, OR 97008
Phone
(503) 535-8302
Fax
(503) 416-8732
NPI assigned
Apr 5, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2016

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

Authorized official

Name
Rahul Naven Desai, MD
Title
Owner / Ceo
Phone
(503) 535-8302

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X DO150752 OR Primary
Vascular & Interventional Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0204X MD28444 OR

Addresses

Primary practice location

9925 SW Nimbus Ave
Suite 100
Beaverton, OR 97008

Mailing address

9925 SW Nimbus Ave.
Suite 100
Beaverton, OR 97008
Phone (503) 535-8302

National Provider Directory

National Provider Directory

Locations

9925 SW Nimbus Ave
Ste 100
Beaverton, OR 97008
Phone (503) 217-6305

17704 Jean Way
Ste 110
Lake Oswego, OR 97035

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": "1365120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476057600000",
    "number": "1801139019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9925 SW NIMBUS AVE.",
            "address_2": "SUITE 100",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "97008",
            "telephone_number": "503-535-8302",
            "fax_number": "503-416-8732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9925 SW NIMBUS AVE",
            "address_2": "SUITE 100",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "97008",
            "telephone_number": "503-535-8302",
            "fax_number": "503-416-8732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORE INTERVENTIONAL SPINE & SPORTS MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-05",
        "last_updated": "2016-10-10",
        "status": "A",
        "authorized_official_last_name": "DESAI",
        "authorized_official_first_name": "RAHUL",
        "authorized_official_middle_name": "NAVEN",
        "authorized_official_title_or_position": "OWNER / CEO",
        "authorized_official_telephone_number": "503-535-8302",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "OR",
            "license": "DO150752",
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "OR",
            "license": "MD28444",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Oct 10, 2016; 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.