NPIMap

Organization Active NPI

Ortholonestar, PLLC

Doing business as Azalea Orthopedics & Sports Medicine Clinic

  • Orthopaedic Surgery Physician
  • Palestine, TX
National Provider Identifier
1114534765
Registry record updated Sep 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
ORTHOLONESTAR, PLLC
Doing business as
Azalea Orthopedics & Sports Medicine Clinic
Practice address
2211 S Loop 256
Palestine, TX 75801-4701
Phone
(903) 939-7500
Fax
(903) 939-7728
NPI assigned
Sep 28, 2020
Last updated
Sep 28, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
ORTHOLONESTAR, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 28, 2020

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

Authorized official

Name
Jennifer Kinman
Title
Ceo
Phone
(512) 439-1000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X Primary

Addresses

Primary practice location

2211 S Loop 256
Palestine, TX 75801-4701

Mailing address

3414 Golden Rd
Tyler, TX 75701-8336
Phone (903) 939-7500

Other names 1

  • Azalea Orthopedics & Sports Medicine Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210430000731 TX DME Supplier - Physician - Orthopedic/Orthopedic Surgery 9931529062 Practice locations: Palestine, TX

National Provider Directory

National Provider Directory
Tax ID family
Ortholonestar PLLC54 organizations share this tax ID, including this one
Part of
Ortholonestar PLLC

Organizations with this tax ID in the same state 17

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 17

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1601251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601251200000",
    "number": "1114534765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3414 GOLDEN RD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757018336",
            "telephone_number": "903-939-7500",
            "fax_number": "903-939-7728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 S LOOP 256",
            "city": "PALESTINE",
            "state": "TX",
            "postal_code": "758014701",
            "telephone_number": "903-939-7500",
            "fax_number": "903-939-7728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOLONESTAR, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ORTHOLONESTAR, PLLC",
        "enumeration_date": "2020-09-28",
        "last_updated": "2020-09-28",
        "certification_date": "2020-09-28",
        "status": "A",
        "authorized_official_last_name": "KINMAN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "512-439-1000"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Azalea Orthopedics & Sports Medicine Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palestine, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2020; 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.