NPIMap

Organization Active NPI

Sport Medicine and Orthopaedic Center Inc

  • Orthopaedic Surgery Physician
  • Chesapeake, VA
National Provider Identifier
1043246556
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
SPORT MEDICINE AND ORTHOPAEDIC CENTER INC
Practice address
501 Discovery Dr.
Chesapeake, VA 23320
Phone
(757) 547-5145
Fax
(757) 436-2480
NPI assigned
Jun 25, 2006
Last updated
Aug 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

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

Authorized official

Name
Debra Runge-Ashby
Title
Director of Revenue Cycle
Phone
(757) 547-5145

Specialties & licenses 12

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Neurological Surgery Physician 207T00000X NU
Orthopaedic Surgery Physician 207X00000X NU Primary
Orthopaedic Hand Surgery Physician 207XS0106X NU
Adult Reconstructive Orthopaedic Surgery Physician 207XS0114X NU
Orthopaedic Surgery of the Spine Physician 207XS0117X NU
Orthopaedic Foot and Ankle Surgery Physician 207XX0004X NU
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X NU
Physical Medicine & Rehabilitation Physician 208100000X NU
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X NU
Foot & Ankle Surgery Podiatrist 213ES0103X NU
Physical Therapist 225100000X NU

Addresses

Primary practice location

501 Discovery Dr.
Chesapeake, VA 23320

Mailing address

501 Discovery Dr
Chesapeake, VA 23320-3832
Phone (757) 547-5145

Other practice location 1

5801 Harbour View Blvd
Suffolk, VA 23435-2657
Phone (757) 547-5145

Other practice location 2

150 Burnetts Way
Suffolk, VA 23434-8168
Phone (757) 547-5145

Other identifiers 1

IdentifierTypeStateIssuer
CL7629OtherVAMEDICARE RAILROAD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050422000382 VA Part B Supplier - Clinic/Group Practice 8921046616 Receives reassigned benefits from 31 practitioners
1 other NPI on this enrollment
Practice locations: Chesapeake, VA; Suffolk, VA
O20100930015019 VA DME Supplier - Physician - Orthopedic/Orthopedic Surgery 8921046616 Practice locations: Chesapeake, VA

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

501 Discovery Dr
Ste 100
Chesapeake, VA 23320
Phone 75754751453502

5801 Harbour View Blvd
Ste 200
Suffolk, VA 23435
Phone 75754751453502

Practitioners & affiliated clinicians

Practitioners 43

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.

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1043246556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 DISCOVERY DR",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233203832",
            "telephone_number": "757-547-5145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 DISCOVERY DR.",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "23320",
            "telephone_number": "757-547-5145",
            "fax_number": "757-436-2480"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5801 Harbour View Blvd",
            "address_purpose": "LOCATION",
            "city": "Suffolk",
            "state": "VA",
            "postal_code": "234352657",
            "country_code": "US",
            "telephone_number": "757-547-5145",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "150 Burnetts Way",
            "address_purpose": "LOCATION",
            "city": "Suffolk",
            "state": "VA",
            "postal_code": "234348168",
            "country_code": "US",
            "telephone_number": "757-547-5145",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SPORT MEDICINE AND ORTHOPAEDIC CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-25",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A",
        "authorized_official_last_name": "RUNGE-ASHBY",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE CYCLE",
        "authorized_official_telephone_number": "757-547-5145"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207XS0106X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207XS0114X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0004X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Foot and Ankle Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CL7629",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesapeake, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2024; 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.