NPIMap

Organization Active NPI

Orthoone Sports Medicine & Orthopaedics, PLLC

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Olive Branch, MS
National Provider Identifier
1053530246
Registry record updated Mar 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
13282 Issued in MS
Legal business name
ORTHOONE SPORTS MEDICINE & ORTHOPAEDICS, PLLC
Practice address
9085 E Sandidge CV
Suite 200
Olive Branch, MS 38654-3575
Phone
(662) 890-2663
Fax
(662) 890-2681
NPI assigned
Apr 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2023

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

Authorized official

Name
Gail Lindberg
Title
Ceo
Phone
(901) 861-9610

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207XX0005X 13282 MS Primary

Addresses

Primary practice location

9085 E Sandidge CV
Suite 200
Olive Branch, MS 38654-3575

Mailing address

PO Box 1866
Collierville, TN 38027-1866
Phone (901) 861-9610

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130507000547 MS Part B Supplier - Clinic/Group Practice 3779738000 Receives reassigned benefits from 6 practitioners
Practice locations: Olive Branch, MS

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory

Locations

9085 Sandidge Center Cv
Ste 250
Olive Branch, MS 38654

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680134400000",
    "number": "1053530246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1866",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380271866",
            "telephone_number": "901-861-9610",
            "fax_number": "901-861-9611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9085 E SANDIDGE CV",
            "address_2": "SUITE 200",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386543575",
            "telephone_number": "662-890-2663",
            "fax_number": "662-890-2681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOONE SPORTS MEDICINE & ORTHOPAEDICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-25",
        "last_updated": "2023-03-30",
        "certification_date": "2023-03-30",
        "status": "A",
        "authorized_official_last_name": "LINDBERG",
        "authorized_official_first_name": "GAIL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "901-861-9610"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "MS",
            "license": "13282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olive Branch, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2023; 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.