Active NPI
Stuart Takeo Johnson, PT
- Physical Therapist
- Bend, OR
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4232
- Practice address
- 1303 NE Cushing Dr
Suite 150
Bend, OR 97701-3891 - Phone
- (541) 382-7875
- Fax
- (541) 382-2181
- NPI assigned
- Feb 6, 2007
- Sex
- Male
- Sole proprietor
- No
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 | 4232 | OR | Primary |
Addresses
Primary practice location
1303 NE Cushing Dr
Suite 150
Bend, OR 97701-3891
Mailing address
805 SW Industrial Way
Suite 3
Bend, OR 97702-1093
Phone (541) 585-2529
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 228894 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1717 NE 2ND St
Redmond, OR 97756-8249
Phone (541) 504-2350
2700 NE 4TH St
Suite 105
Bend, OR 97701-3628
Phone (541) 323-5864
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4232 | OR | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rebound Physical Therapy Limited Partnership | Physical Therapist | Current | Accepting new patients |
| Rebound Physical Therapy Limited Partnership | Physical Therapist | Current | Accepting new patients |
Locations
2700 NE 4th St
Ste 105
Bend, OR 97701
Phone (541) 323-5864
1303 NE Cushing Dr
Ste 150
Bend, OR 97701
Phone (541) 382-7875
805 SW Industrial Way
Ste 3
Bend, OR 97702
Phone (541) 323-5864
51600 Huntington Rd
La Pine, OR 97739
Phone (541) 385-7129
1315 NW 4th St
Apt B
Redmond, OR 97756
Phone (541) 504-2350
1717 NE 2nd St
Redmond, OR 97756
Phone (541) 332-9045
Organizations & group practices 2
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.
-
- Physical Therapist
- Bend, OR
- NPI 1164888764
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- Prineville, OR
- NPI 1497571525
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1356912000000",
"number": "1972642742",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "805 SW INDUSTRIAL WAY",
"address_2": "SUITE 3",
"city": "BEND",
"state": "OR",
"postal_code": "977021093",
"telephone_number": "541-585-2529",
"fax_number": "541-585-2536"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1303 NE CUSHING DR",
"address_2": "SUITE 150",
"city": "BEND",
"state": "OR",
"postal_code": "977013891",
"telephone_number": "541-382-7875",
"fax_number": "541-382-2181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "STUART",
"middle_name": "TAKEO",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-06",
"last_updated": "2012-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "4232",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "228894",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2012; 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.