OrganizationActive
Central Oregon Spine and Sports, LLC
NPI 1497293054 · Physical Medicine & Rehabilitation Physician · Bend, OR
Provider details
- NPI number
- 1497293054
- Entity type
- Organization
- Primary specialty
- Physical Medicine & Rehabilitation PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Kimberly Booher, Administrator(541) 420-4833
- License
- MD152056 (OR)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Established profile(70/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
9 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
2115 Ne Wyatt Ct
Suite 101
Bend, OR 97701-7678
Phone: (541) 420-4833
Fax: (541) 228-3670
Street-level locationGet directions
Mailing address
2115 Ne Wyatt Ct
Bend, OR 97701-7678
Registry dates
- Enumerated
- 2017-02-03
- Last updated
- 2017-02-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.