DMITRIY SHORE (PA-C) – Medical Physician Assistant, NPI 1124177902
Medical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,876 PHYSICIAN ASSISTANT in OR
Provider Addresses for DMITRIY SHORE (PA-C)
10305 SW PARK WAY STE 300
PORTLAND, OR 972255033
Phone: (503) 295-0730
Fax: (503) 295-0731
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 83 Open Payments records for all available years, with a total value of $1,820.
Total Amount is formed as General ($1,820) + Research ($0) + Ownership ($0) = $1,820.
Last reported payment date: 2024-12-23 • Largest payer in this snapshot: ABBVIE INC. ($477).
Total Amount
$1,820
General + Research + Ownership
Payments
83
Total payment records
General Amount
$1,820
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-23
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $477 |
| Collegium Pharmaceutical, Inc. | $302 |
| BIOTRONIK NRO, Inc. | $221 |
| MML US, Inc. | $167 |
| Boston Scientific Corporation | $142 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2014-05-22
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20140522002443 | I | Physician Assistant | OR | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 727 | 149 | $0 |
| 87798 | Detection test by nucleic acid for organism, amplified probe technique | 84 | 12 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 56 | 42 | $0 |
| 80307 | Testing for presence of drug, by chemistry analyzers | 45 | 32 | $0 |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 21 | 21 | $0 |
Insurance plans in this area (ZIP 97225)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | MI | |
| Nurse Practitioner | OR | |
| - | OR | |
| Nurse Practitioner | CA | |
| General Practice | OR | |
| - | NH | |
| Nurse Practitioner | CA | |
| General Practice | OR | |
| Physician Assistant | ME | |
| Physician Assistant | WA |
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