Mary Grace A Bautista, PT
Individual provider Active NPI Physical Therapist · Portland, OR
NPI 1962762260 · NPPES record last updated Dec 29, 2023
Key facts
- NPI
- 1962762260
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT63986 (OR)
- Practice address
- 11782 SW Barnes Rd Ste 300
Portland, OR 97225-5933 - Phone
- (503) 906-4323
- Fax
- (503) 906-4319
- NPI assigned
- May 21, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Orthopedic and Fracture Clinic PC
Practice addresses (Care Compare)
11782 SW Barnes Rd
Suite 300
Portland, OR 97225-5933
Phone (503) 214-5200
Merit-based Incentive Payment System (MIPS)
- Final score
- 54.33 of 100
- Quality
- 57.12
- Promoting interoperability
- 0
- Improvement activities
- 30
- Cost
- 86.48
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210420001951 | OR | Practitioner - Physical Therapist in Private Practice | 6204154206 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT63986 | OR | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Orthopedic & Fracture Clinic PC | Current |
Accepting new patients | |
| Therapeutic Associates Inc | Physical Therapist | Current | Accepting new patients |
| Therapeutic Associates Inc | Physical Therapist | Current |
Accepting new patients |
| Orthopedic & Fracture Clinic PC | Current |
Accepting new patients | |
| Therapeutic Associates Inc | Physical Therapist | Current |
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
14795 SW Murray Scholls Dr
Ste 109
Beaverton, OR 97007
Phone 5039064301 ext. 4301
996 NW Circle Blvd
Ste 101
Corvallis, OR 97330
Phone (541) 757-0878
2911 Tennyson Ave
Ste 204
Eugene, OR 97408
Phone (541) 515-6194
702 SW Ramsey Ave
Ste 220
Grants Pass, OR 97527
Phone (541) 479-0765
5920 NE Ray Cir
Ste 160
Hillsboro, OR 97124
Phone (503) 844-9294
5955 Shoreview Ln N
Ste 100
Keizer, OR 97303
Phone (503) 463-4221
10215 SW Parkway
Ste D
Portland, OR 97225
Phone (503) 292-3583
11782 SW Barnes Rd
Ste 300
Portland, OR 97225
Phone (503) 214-5200
11782 SW Barnes Rd
Ste 100
Portland, OR 97225
Phone (503) 214-5200
8028 NE Glisan St
Ste B
Portland, OR 97213
Phone (503) 253-0924
2040 NW Newcastle St
Roseburg, OR 97471
Phone (541) 673-1808
58147 Columbia River Hwy
Ste A
Saint Helens, OR 97051
Phone (503) 397-1914
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
29100 SW Town Center Loop W
Ste 190
Wilsonville, OR 97070
Phone (503) 570-7600
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT63986 | OR | Yes |
Addresses
Primary practice location
11782 SW Barnes Rd Ste 300
Portland, OR 97225-5933
Mailing address
1426 S Fairfield Ave
Lombard, IL 60148-4669
Other practice location 1
14795 SW Murray Scholls Dr Ste 109
Beaverton, OR 97007-9230
Phone (503) 906-4301 ext. 4301
Other providers in Portland, OR
- Ellen Priscilla Saqueton Bautista Yang
- Josefa Bautista Zacarias
- Alison Bautista
- Irina Bautista
- Jessica Lilliana Bautista
- Melissa KS Bautista
- Cheryl Bauzon
- Julianne Bava
- Tovia Blair Bavly
- Kelly Clark Bawden
All providers in Portland, OR · Physical Therapist in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 29, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.