NPIMap

Organization Active NPI

Pain Solutions Physical Therapy LLC

  • Physical Therapist
  • Salem, OR
National Provider Identifier
1871247338
Registry record updated Feb 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PAIN SOLUTIONS PHYSICAL THERAPY LLC
Practice address
2416 13TH St SE Ste B
Salem, OR 97302-2546
Phone
(503) 894-2826
Fax
(949) 862-5129
NPI assigned
Feb 3, 2022
Last updated
Feb 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2022

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

Authorized official

Name
Jason Gough, DPTNPI 1639749583
Title
Owner
Phone
(503) 385-8026

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

2416 13TH St SE Ste B
Salem, OR 97302-2546

Mailing address

1050 E Flamingo Rd Ste 228
Las Vegas, NV 89119-7435
Phone (833) 764-0178

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220203002477 OR Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5092108654 Receives reassigned benefits from 2 practitioners
Practice locations: Salem, OR

National Provider Directory

National Provider Directory

Locations

1050 E Flamingo Rd
Ste 228
Las Vegas, NV 89119

2416 13th St SE
Ste B
Salem, OR 97302
Phone (503) 385-8026

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1643846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645488000000",
    "number": "1871247338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 E FLAMINGO RD STE 228",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891197435",
            "telephone_number": "833-764-0178",
            "fax_number": "949-276-5401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2416 13TH ST SE STE B",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973022546",
            "telephone_number": "503-894-2826",
            "fax_number": "949-862-5129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN SOLUTIONS PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-03",
        "last_updated": "2022-02-22",
        "certification_date": "2022-02-22",
        "status": "A",
        "authorized_official_last_name": "GOUGH",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-385-8026",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2022; 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.

Verify at the official NPI Registry.