Individual provider Active NPI

Shawn Vindel Dailey, PT

  • Physical Therapist
  • Portland, OR
National Provider Identifier
1801879614
Registry record updated Nov 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5000 Issued in OR
Practice address
4829 NE Martin Luther King Blvd
Ste 101
Portland, OR 97211-3351
Phone
(503) 283-8133
Fax
(503) 289-2312
NPI assigned
Nov 25, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5000 OR Primary

Addresses

Primary practice location

4829 NE Martin Luther King Blvd
Ste 101
Portland, OR 97211-3351

Mailing address

16083 SW Upper Boones Ferry Rd
Ste 300
Tigard, OR 97224-7736
Phone (800) 219-8835

Other identifiers 1

IdentifierTypeStateIssuer
213465MedicaidOR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050804000693 OR Practitioner - Physical Therapist in Private Practice 6103855762 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Therapeutic Associates IncGroup PAC ID 0042116279, 319 clinicians

Practice addresses (Care Compare)

20055 SW Pacific Hwy
Suite 110
Sherwood, OR 97140-9294
Phone (503) 625-1691

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5000ORMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Therapeutic Associates Inc Physical Therapist Current Accepting new patients
Therapeutic Associates Inc Physical Therapist CurrentSince Jun 13, 2005 Accepting new patients
Therapeutic Associates Inc Physical Therapist CurrentSince Jun 13, 2005 Accepting new patients
Therapeutic Associates Inc Physical Therapist Past Accepting new patients
Therapeutic Associates Inc Physical Therapist Past Accepting new patients

Locations

16315 SW Barrows Rd
Ste 205
Beaverton, OR 97007
Phone (503) 521-0500

4829 NE Mlk Jr Blvd
Ste 101
Portland, OR 97211
Phone (503) 283-8133

1307 NE 102nd Ave
Ste G
Portland, OR 97220
Phone (503) 253-0924

20055 SW Pacific Hwy
Ste 110
Sherwood, OR 97140
Phone (503) 625-1691

16083 SW Upper Boones Ferry Rd
Ste 300
Tigard, OR 97224
Phone (503) 443-6153

Interoperability endpoints

  • Direct secure messaging: shawn.dailey.1@31414.direct.athenahealth.com

Organizations & group practices 5

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": "1132876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351814400000",
    "number": "1801879614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16083 SW UPPER BOONES FERRY RD",
            "address_2": "STE 300",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247736",
            "telephone_number": "800-219-8835",
            "fax_number": "503-639-9699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4829 NE MARTIN LUTHER KING BLVD",
            "address_2": "STE 101",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972113351",
            "telephone_number": "503-283-8133",
            "fax_number": "503-289-2312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAILEY",
        "first_name": "SHAWN",
        "middle_name": "VINDEL",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-25",
        "last_updated": "2012-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "5000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "213465",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.