RESTORE INTERVENTIONAL SPINE & SPORTS MEDICINE LLC (NPI# 1801139019) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801139019 |
| Entity Type | Organization |
| Organization Name | RESTORE INTERVENTIONAL SPINE & SPORTS MEDICINE LLC |
| Practice Address |
9925 Sw Nimbus Ave Suite 100 Beaverton OR 97008 |
| Mailing Address |
9925 Sw Nimbus Ave. Suite 100 Beaverton OR 97008 |
| Practice Telephone | 5035358302 |
| Practice Fax Number | 5034168732 |
| Mailing Telephone | 5035358302 |
| Mailing Fax Number | 5034168732 |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2016-10-10 |
| Authorized Official Name | RAHUL NAVEN DESAI (OWNER / CEO) |
| Authorized Official Telephone | 5035358302 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
MD28444 | OR | Allopathic & Osteopathic Physicians |
| Y | 2081P2900X |
Physical Medicine & Rehabilitation Specialization: Pain Medicine |
DO150752 | OR | Allopathic & Osteopathic Physicians |
| Street Address |
9925 SW NIMBUS AVE SUITE 100 |
| City | BEAVERTON |
| State | OR |
| Zip Code | 97008 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003028218 | Julie A Figliulo | Massage Therapist | 9925 Sw Nimbus Ave, Suite 100, Beaverton, OR 97008-7387 | 2007-05-03 |
| 1386185064 | Tyler Schuster | Specialist/Technologist | 9925 Sw Nimbus Ave, Beaverton, OR 97008-7591 | 2017-03-15 |
| 1861800740 | Sheila Raybourn | Chiropractor | 9925 Sw Nimbus Ave, Suite 100, Beaverton, OR 97008-7591 | 2014-07-23 |
| 1467718908 | Katarzyna Barbara Iwan | Pain Medicine | 9925 Sw Nimbus Ave, #100, Beaverton, OR 97008-7591 | 2012-04-10 |
| 1710139449 | Harold J Maderazo | Naturopath | 9925 Sw Nimbus Ave, Suite 100, Beaverton, OR 97008-7387 | 2008-10-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972136638 | Kelly Mitchell | Counselor | 6600 Sw 105th Ave Suite 120, Beaverton, OR 97008 | 2020-02-20 |
| 1700305315 | Heather Denise Glenn | Counselor | 6700 Sw 105th Avenue, Suite 203, Beaverton, OR 97008 | 2017-09-14 |
| 1649798265 | Timothy Wilkins | Counselor | 8285 Sw Nimbus Ave #148, Beaverton, OR 97008 | 2017-09-04 |
| 1962920751 | West End Surgical, LLC | Clinic/Center | 9405 Sw Nimbus Ave, Beaverton, OR 97008 | 2017-09-01 |
| 1073054714 | University Professional Services | Durable Medical Equipment & Medical Supplies | 9317 Sw Nimbus Ave, Beaverton, OR 97008 | 2017-03-14 |
| 1508311424 | Mitra Gaspeed | Dental Hygienist | 8615 Sw Thoroughbred Pl., Beaverton, OR 97008 | 2016-08-20 |
| 1740521988 | Donna Louise Grenier | Registered Nurse | 1413 E St, Independence, OR 97008 | 2013-03-13 |
| 1508105735 | Mary Elizabeth Smith | Specialist/Technologist, Other | 11855sw Ridgecrest Dr, #209, Beaverton, OR 97008 | 2013-02-07 |
| 1629315551 | Adelfino J Zuriaga | Massage Therapist | 11985 Sw Camden Ln, Beaverton, OR 97008 | 2013-01-11 |
| 1760738330 | Lih-wern Wang | Pharmacist | 9775 Sw Gemini Dr Ste 1, Beaverton, OR 97008 | 2012-07-31 |
| Find all providers in zip 97008 | ||||
| Taxonomy Code | 2081P2900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Physical Medicine & Rehabilitation |
| Specialization | Pain Medicine |
| A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source changed] Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007. http://www.abpmr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation. A subspecialty certificate was approved by the ABMS in 1999. ACGME Accredited Residency Program Requirements: Proposal under development. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215434519 | Lags Spine and Sportscare Medical Centers, Inc. | Physical Medicine & Rehabilitation | 17175 Sw Tualatin Valley Hwy Ste A-1, Beaverton, OR 97003-4584 | 2018-04-12 |
| 1902117898 | Jennifer K Cann | Physical Medicine & Rehabilitation | 9400 Sw Beaverton Hillsdale Hwy Ste 205, Beaverton, OR 97005-3349 | 2010-06-25 |
| 1407335979 | Lags Spine and Sportscare Medical Centers, Inc. | Physical Medicine & Rehabilitation | 17175 Sw Tualatin Valley Hwy, Beaverton, OR 97003-4584 | 2018-08-07 |
| 1588171706 | Tony Havens | Physical Medicine & Rehabilitation | 3835 Sw 185th Ave Ste 400, Beaverton, OR 97078-1553 | 2018-01-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225650864 | David Edison Harris | Physical Medicine & Rehabilitation | 707 Murphy Rd Ste 101, Medford, OR 97504-8520 | 2020-05-16 |
| 1265062202 | Resurgent Health, LLC | Physical Medicine & Rehabilitation | 2850 Se Powell Valley Rd Ste 205a, Gresham, OR 97080-1489 | 2020-01-17 |
| 1568003887 | Transform Health LLC | Physical Medicine & Rehabilitation | 1200 Executive Pkwy Ste 260, Eugene, OR 97401-2199 | 2019-10-08 |
| 1275037020 | Daniel Eric Marsh Jr. | Physical Medicine & Rehabilitation | 14290 Marjorie Ln Apt 2098, Oregon City, OR 97045-7863 | 2018-03-19 |
| 1013417351 | Burnside Surgery Center LLC | Physical Medicine & Rehabilitation | 689 Nw Burnside Rd Fl 1, Gresham, OR 97030-3739 | 2018-02-13 |
| 1639303597 | Trevor Dee Jorgensen | Physical Medicine & Rehabilitation | 2003 Cedar St, Forest Grove, OR 97116-1701 | 2009-05-07 |
| 1033319124 | Gregory M Phillips | Physical Medicine & Rehabilitation | 74b Centennial Loop Ste 300, Neurospine Institute LLC, Eugene, OR 97401-7925 | 2007-07-18 |
| 1144428079 | Rebeca M Monreal | Physical Medicine & Rehabilitation | 1100 22nd St Se, Salem, OR 97302-6558 | 2007-07-03 |
| 1316423734 | Lags Spine and Sportscare Medical Centers, Inc. | Physical Medicine & Rehabilitation | 1015 25th St Se, Salem, OR 97301-5049 | 2018-07-18 |
| 1982101143 | Lags Spine and Sportscare Medical Centers, Inc. | Physical Medicine & Rehabilitation | 169 Ne 102nd Ave, Portland, OR 97220-4169 | 2018-04-12 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.