NPIMap

Organization Active NPI

Performance Spine and Sports Medicine of Newtown, LLC

  • Durable Medical Equipment & Medical Supplies
  • Newtown, PA
National Provider Identifier
1104161884
Registry record updated Oct 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
MD440879 Issued in PA
Legal business name
PERFORMANCE SPINE AND SPORTS MEDICINE OF NEWTOWN, LLC
Practice address
828A Newtown Yardley Rd
Newtown, PA 18940-4012
Phone
(215) 504-2223
Fax
(215) 504-2141
NPI assigned
Dec 6, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2013

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

Authorized official

Name
Dr. Matthias Heinz Wiederholz, M.D.
Title
Owner
Phone
(215) 504-2223

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X MD440879 PA Primary

Addresses

Primary practice location

828A Newtown Yardley Rd
Newtown, PA 18940-4012

Mailing address

828A Newtown Yardley Rd
Newtown, PA 18940-4012
Phone (215) 504-2223

National Provider Directory

National Provider Directory

Locations

828A Newtown Yardley Rd
Newtown, PA 18940
Phone (215) 369-3555

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1354752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380672000000",
    "number": "1104161884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "828A NEWTOWN YARDLEY RD",
            "city": "NEWTOWN",
            "state": "PA",
            "postal_code": "189404012",
            "telephone_number": "215-504-2223",
            "fax_number": "215-504-2141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "828A NEWTOWN YARDLEY RD",
            "city": "NEWTOWN",
            "state": "PA",
            "postal_code": "189404012",
            "telephone_number": "215-504-2223",
            "fax_number": "215-504-2141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFORMANCE SPINE AND SPORTS MEDICINE OF NEWTOWN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-06",
        "last_updated": "2013-10-02",
        "status": "A",
        "authorized_official_last_name": "WIEDERHOLZ",
        "authorized_official_first_name": "MATTHIAS",
        "authorized_official_middle_name": "HEINZ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "215-504-2223",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "PA",
            "license": "MD440879",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newtown, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2013; 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.