Individual provider Active NPI

Candis Synsvoll, PT

  • Physical Therapist
  • Portland, OR
National Provider Identifier
1922156363
Registry record updated Nov 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
4089 Issued in OR
Practice address
1423 SE 23Rd Ave
Portland, OR 97214-3908
Phone
(503) 236-3108
Fax
(503) 236-3239
NPI assigned
Jan 8, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2007

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 4089 OR Primary

Addresses

Primary practice location

1423 SE 23Rd Ave
Portland, OR 97214-3908

Mailing address

1423 SE 23Rd Ave
Portland, OR 97214-3908
Phone (503) 236-3108

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120130000200 OR Practitioner - Physical Therapist in Private Practice 2567629801 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
360 Degree Sports Medicine and Spine Therapy LLCGroup PAC ID 8729164249, 6 clinicians

Practice addresses (Care Compare)

1215 SE 8TH Ave
Suite D
Portland, OR 97214-3497
Phone (503) 248-0360

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4089ORMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Therapeutic Associates Inc Physical Therapist Past Accepting new patients
New Heights Integrative Therapy Inc Physical Therapist PastSince Oct 2, 2017 Accepting new patients
New Heights Integrative Therapy, Inc. Physical Therapist Past Accepting new patients
Therapeutic Associates Inc Physical Therapist Past Accepting new patients

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": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194220800000",
    "number": "1922156363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1423 SE 23RD AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972143908",
            "telephone_number": "503-236-3108",
            "fax_number": "503-236-3239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1423 SE 23RD AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972143908",
            "telephone_number": "503-236-3108",
            "fax_number": "503-236-3239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SYNSVOLL",
        "first_name": "CANDIS",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-08",
        "last_updated": "2007-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "4089",
            "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 Nov 5, 2007; 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.