NPIMap

Organization Active NPI

Southwest Sports and Spine LLC

  • Physical Medicine & Rehabilitation Physician
  • Tucson, AZ
National Provider Identifier
1033448576
Registry record updated Jul 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
SOUTHWEST SPORTS AND SPINE LLC
Practice address
5860 N la Cholla Blvd Ste 150
Tucson, AZ 85741-3562
Phone
(520) 395-0512
Fax
(520) 505-4108
NPI assigned
Dec 11, 2009
Last updated
Jul 21, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2014

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

Authorized official

Name
Dr. Eugene Johnson, MDNPI 1851307276
Title
President
Phone
(520) 395-0512

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208100000X AZ
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208100000X Primary

Addresses

Primary practice location

5860 N la Cholla Blvd Ste 150
Tucson, AZ 85741-3562

Mailing address

PO Box 70232
Tucson, AZ 85737-0030
Phone (520) 395-0512

Other identifiers 1

IdentifierTypeStateIssuer
498019MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100308000879 AZ Part B Supplier - Clinic/Group Practice 8527103076 Receives reassigned benefits from 2 practitioners
Practice locations: Tucson, AZ
O20121226000372 AZ DME Supplier - Physician - Interventional Pain Management 8527103076 Practice locations: Tucson, AZ

National Provider Directory

National Provider Directory
Tax ID family
Southwest Sports and Spine2 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.

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1260489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405900800000",
    "number": "1033448576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70232",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857370030",
            "telephone_number": "520-395-0512",
            "fax_number": "520-505-4108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5860 N LA CHOLLA BLVD STE 150",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857413562",
            "telephone_number": "520-395-0512",
            "fax_number": "520-505-4108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST SPORTS AND SPINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-11",
        "last_updated": "2014-07-21",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "520-395-0512",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "AZ",
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "498019",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2014; 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.