Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dmitriy Shore, PA-C

Individual provider Medical Physician Assistant · NPI 1124177902

Dmitriy Shore, PA-C is a Physician Assistant in Portland, Oregon. Qualified in 2000, 26 years ago. Practices with Advanced Pain Management Center PC, a 3-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Oregon.

Years since qualifying
26
Licensed in
OR
In the registry since
2007
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

10305 SW Park Way Ste 300
Portland, OR 97225-5033
Phone: (503) 295-0730
Fax: (503) 295-0731
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence PA00724 (OR)

Record details

NPI number1124177902
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJanuary 9, 2007
Last updated in NPPESJuly 8, 2007

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2000 (26 years in practice)
Group practice Advanced Pain Management Center Pc — 3 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations6 on file with Medicare

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