NPIMap

Organization Active NPI

Sun Valley Sports Medicine, P.a.

  • Orthopaedic Surgery Physician
  • Ketchum, ID
National Provider Identifier
1124061163
Registry record updated Jun 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
SUN VALLEY SPORTS MEDICINE, P.A.
Practice address
191 5TH St W
Ketchum, ID 83340
Phone
(208) 726-5207
Fax
(208) 726-8948
NPI assigned
Jun 14, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Stephen Wasilweski, M.D.
Title
Physician
Phone
(208) 726-5207

Practitioners 6

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

National Provider Directory

National Provider Directory

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207X00000X Primary
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207XX0005X

Addresses

NPPES NPI Registry

Primary practice location

191 5TH St W
Ketchum, ID 83340

Mailing address

191 5TH St W
Ketchum, ID 83340
Phone (208) 726-5207

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
200015728OtherIDRR MEDICARE
805960600MedicaidID

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 17, 2008.

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1124061163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "191 5TH ST W",
            "city": "KETCHUM",
            "state": "ID",
            "postal_code": "83340",
            "telephone_number": "208-726-5207",
            "fax_number": "208-726-8948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 5TH ST W",
            "city": "KETCHUM",
            "state": "ID",
            "postal_code": "83340",
            "telephone_number": "208-726-5207",
            "fax_number": "208-726-8948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUN VALLEY SPORTS MEDICINE, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-14",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "WASILWESKI",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "208-726-5207",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "200015728",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805960600",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ketchum, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; 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.