Sports Medicine Center S C

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

Legal business name

SPORTS MEDICINE CENTER S C

Practice address

277 Altenhofen Dr
Appleton, WI 54913-8401

Phone

(920) 993-1643

Fax

(920) 993-1645

NPI assigned

Jul 27, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Etienne A Mejia, M.D.NPI 1184648131

Title

Presdient

Phone

(920) 993-1643

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Practitioners 2

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

• Etienne A. Mejia, M.D.

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Appleton, WI
  • NPI 1184648131
  Medicare reassignment Care Compare group NPD Authorized official
• Amanda Bachman

  • Nurse Practitioner
  • Green Bay, WI
  • NPI 1295128239
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1232409600000",
    "number": "1093729055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "277 ALTENHOFEN DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549138401",
            "telephone_number": "920-993-1643",
            "fax_number": "920-993-1645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "277 ALTENHOFEN DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549138401",
            "telephone_number": "920-993-1643",
            "fax_number": "920-993-1645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTS MEDICINE CENTER S C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2009-01-20",
        "status": "A",
        "authorized_official_last_name": "MEJIA",
        "authorized_official_first_name": "ETIENNE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESDIENT",
        "authorized_official_telephone_number": "920-993-1643",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John E Sowin, M.D.
• Loreli E Spaay-Joslin, RN
• Jacklyn M Spates, APNP
• Elizabeth A Specht, APSW
• Spine Capital Wisconsin LLC
• Nicole Spradley
• Carlissa Mae Spreeman, RD
• James E Springborn, DDS
• Errol Ray Springer, MD
• Kaitlyn Fern Springer, PHARMD

• Orthopaedic Surgery Physician in Appleton, WI
• Providers in Appleton, WI by specialty
• Orthopaedic Surgery Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2009; 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.