NPIMap

Organization Active NPI

Orlando Sports Medicine Group Inc

  • Multi-Specialty Clinic/Center
  • Orlando, FL
National Provider Identifier
1023129178
Registry record updated Aug 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
ORLANDO SPORTS MEDICINE GROUP INC
Practice address
12780 Waterford Lakes Pkwy
Suite 115
Orlando, FL 32828-4500
Phone
(407) 207-7188
Fax
(407) 207-7103
NPI assigned
Aug 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Eric Greeno, PTNPI 1669574331
Title
President
Phone
(407) 207-7188

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

12780 Waterford Lakes Pkwy
Suite 115
Orlando, FL 32828-4500

Mailing address

12780 Waterford Lakes Pkwy
Suite 115
Orlando, FL 32828-4500
Phone (407) 207-7188

Other identifiers 1

IdentifierTypeStateIssuer
Y902TOtherFLBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141222000499 FL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0840225785 Receives reassigned benefits from 14 practitioners
Practice locations: Altamonte Springs, FL; Orlando, FL

National Provider Directory

National Provider Directory
Tax ID family
Orlando Sports Medicine Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

745 Orienta Ave
Ste 1015
Altamonte Springs, FL 32701
Phone (407) 332-7816

1615 Edgewater Dr
Ste 180
Orlando, FL 32804
Phone (407) 601-6412

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219104000000",
    "number": "1023129178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12780 WATERFORD LAKES PKWY",
            "address_2": "SUITE 115",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328284500",
            "telephone_number": "407-207-7188",
            "fax_number": "407-207-7103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12780 WATERFORD LAKES PKWY",
            "address_2": "SUITE 115",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328284500",
            "telephone_number": "407-207-7188",
            "fax_number": "407-207-7103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORLANDO SPORTS MEDICINE GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2008-08-19",
        "status": "A",
        "authorized_official_last_name": "GREENO",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-207-7188",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "Y902T",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.