NPIMap

Organization Active NPI

Columbia Pain and Spine Institute

  • Physical Medicine & Rehabilitation Physician
  • Gresham, OR
National Provider Identifier
1972813962
Registry record updated May 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
COLUMBIA PAIN AND SPINE INSTITUTE
Practice address
689 NW Burnside Road
Gresham, OR 97030
Phone
(503) 382-8100
Fax
(503) 382-8120
NPI assigned
Oct 8, 2010
Last updated
May 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2021

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

Authorized official

Name
Oleg Maksimov, MDNPI 1780796326
Title
President
Phone
(503) 915-9217

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Clinic/Center 261QP3300X MD 28526 OR
Pain Clinic/Center 261QP3300X MD60054432 WA
Physical Medicine & Rehabilitation Physician 208100000X NU Primary

Addresses

Primary practice location

689 NW Burnside Road
Gresham, OR 97030

Mailing address

689 NW Burnside Road
Gresham, OR 97030-8014
Phone (503) 382-8100

Other identifiers 1

IdentifierTypeStateIssuer
500632340MedicaidOR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180711003656 OR Part B Supplier - Clinic/Group Practice 2769738301 Receives reassigned benefits from 11 practitioners
Practice locations: Gresham, OR

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
38D2018576Columbia Pain and Spine Institute689 NW Burnside Rd, Gresham, OR 97030AccreditationOct 16, 2026

National Provider Directory

National Provider Directory

Locations

831 NW Council Dr
Ste 300
Gresham, OR 97030
Phone (503) 258-4600

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1286496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621728000000",
    "number": "1972813962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "689 NW BURNSIDE ROAD",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970308014",
            "telephone_number": "503-382-8100",
            "fax_number": "503-382-8120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "689 NW BURNSIDE ROAD",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "97030",
            "telephone_number": "503-382-8100",
            "fax_number": "503-382-8120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIA PAIN AND SPINE INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-08",
        "last_updated": "2021-05-23",
        "certification_date": "2021-05-23",
        "status": "A",
        "authorized_official_last_name": "MAKSIMOV",
        "authorized_official_first_name": "OLEG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-915-9217",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "OR",
            "license": "MD 28526",
            "primary": false
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "WA",
            "license": "MD60054432",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500632340",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gresham, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2021; 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.