NPIMap

Organization Active NPI

Orthopedic & Sports Medicine Center LLC

  • Specialist
  • Saint Joseph, MO
National Provider Identifier
1093780645
Registry record updated Jul 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
ORTHOPEDIC & SPORTS MEDICINE CENTER LLC
Practice address
3107 Frederick Ave
Suite B
Saint Joseph, MO 64506-2911
Phone
(816) 233-9888
Fax
(816) 233-0414
NPI assigned
Feb 17, 2006
Last updated
Jul 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2024

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

Authorized official

Name
Sioux Kearnes
Title
Office Manager
Phone
(816) 233-9888

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary
Physical Therapy Clinic/Center 261QP2000X NU

Addresses

Primary practice location

3107 Frederick Ave
Suite B
Saint Joseph, MO 64506-2911

Mailing address

3107 Frederick Ave
Suite B
Saint Joseph, MO 64506-2911
Phone (816) 233-9888

Other practice location 1

3105 Frederick Ave
Saint Joseph, MO 64506-2960
Phone (816) 233-9888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040903000403 MO Part B Supplier - Clinic/Group Practice 5294700449 Receives reassigned benefits from 28 practitioners
Practice locations: Saint Joseph, MO
O20100930049922 MO DME Supplier - Physician - Orthopedic/Orthopedic Surgery 5294700449 Practice locations: Saint Joseph, MO

National Provider Directory

National Provider Directory

Locations

3105 Frederick Ave
Saint Joseph, MO 64506
Phone (816) 233-9888

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719964800000",
    "number": "1093780645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3107 FREDERICK AVE",
            "address_2": "SUITE B",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645062911",
            "telephone_number": "816-233-9888",
            "fax_number": "816-233-0414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3107 FREDERICK AVE",
            "address_2": "SUITE B",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645062911",
            "telephone_number": "816-233-9888",
            "fax_number": "816-233-0414"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3105 Frederick Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Joseph",
            "state": "MO",
            "postal_code": "645062960",
            "country_code": "US",
            "telephone_number": "816-233-9888",
            "fax_number": "816-233-0414",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ORTHOPEDIC & SPORTS MEDICINE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-17",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A",
        "authorized_official_last_name": "KEARNES",
        "authorized_official_first_name": "SIOUX",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "816-233-9888"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Joseph, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 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.