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DMITRIY SHORE PA-C
NPI 1124177902
Physician Assistant - Medical in Portland, OR

Active since January 09, 2007PECOS EnrolledAccepts Medicare Assignment
68.46/100
CMS Quality Rating
10305 SW PARK WAY STE 300, PORTLAND, OR 97225(503) 295-0730(503) 295-0731 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dmitriy Shore Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DMITRIY SHORE PA-C (NPI 1124177902) is an individual medical provider in Portland, Oregon, licensed in Oregon (PA00724) and active in the NPI registry since January 2007. He is enrolled in Medicare PECOS, is affiliated with Providence St Vincent Medical Center, and is a graduate of Other (2000).

NPPES Registry Identity

NPI1124177902
Entity TypeIndividualMale
Primary Taxonomy363AM0700X
Provider Legal NameDMITRIY SHORECredential: PA-C
Location Address10305 SW PARK WAY STE 300Portland, OR 97225-5033
Mailing Address10305 Sw Park Way Ste 300Portland, OR 97225-5033 · (503) 295-0730 · Fax (503) 295-0731
Phone(503) 295-0730
Fax(503) 295-0731
Sole ProprietorNo
Medical School CMSOtherGraduated 2000
Enumeration DateJanuary 9, 2007
Last NPPES UpdateJuly 8, 2007
✔ NPI 1124177902 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in OR · PA00724
10305 SW PARK WAY STE 300, Portland, OR 97225
Open in Google Maps ↗

Other Identifiers 2

Medicare UPINQ37415OR
Medicare ID-Type Unspecified130729OR

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc., Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dmitriy Shore Pa-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9830143460
PECOS Enrollment IDI20140522002443
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 8

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
751 services174 patients
Testing for presence of drug, by chemistry analyzers 80307
Chemistry analyzers are used to detect the presence of drugs in your system. This test involves taking a small sample of your blood or urine. The sample is then analyzed for specific substances. The results help in understanding your health condition better.
124 services87 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
106 services80 patients
Evaluation of neuropsychological test, first hour 96132
An evaluation of neuropsychological tests is a process to assess your brain's function. It involves tasks designed to measure cognitive abilities such as memory, attention, problem-solving, and language skills. The first hour involves initial testing and observation.
42 services33 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
28 services28 patients
Administration of psychological or neuropsychological test by technician, first 30 minutes 96138
This procedure involves a trained technician administering a psychological or neuropsychological test. It's a process that assesses your mental function and behavior. The initial session will last 30 minutes. The aim is to understand your cognitive abilities better.
25 services21 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Providence St Vincent Medical Center

Acute Care Hospitals · Portland, OR
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number380004
Location9205 SW Barnes RoadPortland, OR 97225 · Washington County
Emergency services Birthing friendly

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

68.46/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality65.92
Promoting Interoperability85
Improvement Activities40
Cost38.83

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ADVANCED PAIN MANAGEMENT CENTER PC
Pain Medicine (Pain Medicine)
10305 SW PARK WAY STE 300
PORTLAND, OR 97225
Washington County (503) 295-0730

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dmitriy Shore's NPI number?

The NPI number for Dmitriy Shore is 1124177902. It was assigned to this individual provider in the NPPES registry on January 9, 2007.

Where is Dmitriy Shore located?

Dmitriy Shore practices at 10305 SW Park Way Ste 300, Portland, OR 97225. The listed phone number is (503) 295-0730.

What is Dmitriy Shore's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Dmitriy Shore enrolled in Medicare?

Yes. Dmitriy Shore is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Dmitriy Shore accept?

Health plans from Moda Health Plan, Inc. and Providence Health Plan list Dmitriy Shore as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Dmitriy Shore affiliated with any hospitals?

According to CMS data, Dmitriy Shore is affiliated with Providence St Vincent Medical Center.

When was this NPI record last updated?

The NPPES record for Dmitriy Shore was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.