Active NPI
Stuart G Stark, PT
- Physical Therapist
- Portland, OR
National Provider Identifier
1851335558
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1472
- Practice address
- 6840 S Macadam Ave
Portland, OR 97219-2314 - Phone
- (503) 936-8640
- Fax
- (503) 907-7779
- NPI assigned
- Jun 15, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1472 | OR | Primary |
Addresses
Primary practice location
6840 S Macadam Ave
Portland, OR 97219-2314
Mailing address
333 NW 9TH Ave Unit 1110
Portland, OR 97209-3345
Phone (503) 936-8640
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040714001296 | OR | Practitioner - Physical Therapist in Private Practice | 3678552627 | Practice locations: Portland, OR |
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1979
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
4004 SW Kelly Ave
Suite 207
Portland, OR 97239-4389
Phone (503) 936-8640
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1472 | OR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643155200000",
"number": "1851335558",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "333 NW 9TH AVE UNIT 1110",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972093345",
"telephone_number": "503-936-8640",
"fax_number": "503-907-7779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6840 S MACADAM AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972192314",
"telephone_number": "503-936-8640",
"fax_number": "503-907-7779"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STARK",
"first_name": "STUART",
"middle_name": "G",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-15",
"last_updated": "2022-01-26",
"certification_date": "2022-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "1472",
"primary": true
}
],
"identifiers": [],
"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 Jan 26, 2022; 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.