Ortho Sport & Spine Physicians of Mississippi, LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

ORTHO SPORT & SPINE PHYSICIANS OF MISSISSIPPI, LLC

Practice address

4316 Old Canton Rd
Jackson, MS 39211-5995

Phone

(601) 202-3965

NPI assigned

Nov 14, 2022

Last updated

Nov 14, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Faith Beltzhoover

Title

Revenue Cycle Management Director

Phone

(678) 752-7246

Specialties & licenses 1

Addresses

Tax ID family

Ortho Sport Spine Phy of Mississippi2 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.

• Ortho Sport & Spine Physicians Southhaven

  • Physical Medicine & Rehabilitation Physician
  • Southaven, MS
  • NPI 1659208361
  NPD tax ID

Locations

Practitioners 3

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.

• Samantha Clark, NP-C

  • Family Nurse Practitioner
  • Clinton, MS
  • NPI 1841682044
  NPD (past)
• Michael W. Lane, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Indianapolis, IN
  • NPI 1073573465
  NPD (past)
• Jeffrey Yoonsuk Lee, DO

  • Physical Medicine & Rehabilitation Physician
  • Ridgefield, WA
  • NPI 1316145675
  NPD (past)

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

{
    "created_epoch": "1668384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668384000000",
    "number": "1073221545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5788 ROSWELL RD",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303284904",
            "telephone_number": "678-752-7246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4316 OLD CANTON RD",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392115995",
            "telephone_number": "601-202-3965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHO SPORT & SPINE PHYSICIANS OF MISSISSIPPI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-14",
        "last_updated": "2022-11-14",
        "certification_date": "2022-11-14",
        "status": "A",
        "authorized_official_last_name": "BELTZHOOVER",
        "authorized_official_first_name": "FAITH",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGEMENT DIRECTOR",
        "authorized_official_telephone_number": "678-752-7246"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mariano L Orca, MD
• Jeffrey D. Orledge, MD
• Kirby J Orme, MD
• Randall Orr, RPSGT
• Wayne Shannon Orr III, M.D.
• Ortho Sport and Spine Physicians Jackson
• Orthopedic Resource Services, Inc
• Orthotic & Prosthetic Solutions LLC
• Erica Moore Ory, M.D.
• Casey Orzechowicz, M.D.

• Physical Medicine & Rehabilitation Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Physical Medicine & Rehabilitation Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.