NPIMap

Organization Active NPI

Pacific Sports and Interventional Spine, LLC

Doing business as Pacific Sports and Spine

  • Interventional Pain Medicine Physician
  • Springfield, OR
National Provider Identifier
1881186336
Registry record updated Jul 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
MD27887 Issued in OR
Legal business name
PACIFIC SPORTS AND INTERVENTIONAL SPINE, LLC
Doing business as
Pacific Sports and Spine
Practice address
2445 Beverly St Ste B
Springfield, OR 97477-1910
Phone
(541) 686-3791
Fax
(541) 686-3795
NPI assigned
May 31, 2018
Last updated
Jul 21, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2026

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

Authorized official

Name
Leslie Rea
Title
Practice Manager
Phone
(541) 743-9003

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine Physician 208VP0014X MD27887 OR Primary
Interventional Pain Medicine Physician 208VP0014X MD28629 OR
Physician Assistant 363A00000X PA00800 OR
Physician Assistant 363A00000X PA00420 OR
Physician Assistant 363A00000X PA152998 OR

Addresses

Primary practice location

2445 Beverly St Ste B
Springfield, OR 97477-1910

Mailing address

2445 Beverly St Ste B
Springfield, OR 97477-1910
Phone (541) 743-9003

Other identifiers 5

IdentifierTypeStateIssuer
500604467MedicaidOR
244117MedicaidOR
500608609MedicaidOR
500632183MedicaidOR
500624453MedicaidOR

Other names 1

  • Pacific Sports and Spine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20181126002029 OR Part B Supplier - Clinic/Group Practice 3072867316 Receives reassigned benefits from 20 practitioners
Practice locations: Sutherlin, OR; Springfield, OR; Eugene, OR
O20210917000233 OR DME Supplier - Physician - General Practice 3072867316 Practice locations: Springfield, OR

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D2339431Pacific Sports and Spine LLC2445 Beverly Street Suite B, Springfield, OR 97477Certificate of waiverMar 1, 2028

National Provider Directory

National Provider Directory

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

2445 Beverly St
Ste B
Springfield, OR 97477

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1527724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784592000000",
    "number": "1881186336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2445 BEVERLY ST STE B",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974771910",
            "telephone_number": "541-743-9003",
            "fax_number": "541-284-0520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2445 BEVERLY ST STE B",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974771910",
            "telephone_number": "541-686-3791",
            "fax_number": "541-686-3795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC SPORTS AND INTERVENTIONAL SPINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-31",
        "last_updated": "2026-07-21",
        "certification_date": "2026-07-21",
        "status": "A",
        "authorized_official_last_name": "REA",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "541-743-9003"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "OR",
            "license": "MD27887",
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "OR",
            "license": "MD28629",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA00800",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA00420",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA152998",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500604467",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "244117",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500608609",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500632183",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500624453",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Sports and Spine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springfield, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2026; 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.