NPIMap

Organization Active NPI

Center for Orthopaedic and Sports Medicine PC

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Indiana, PA
National Provider Identifier
1124088372
Registry record updated Mar 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
MD034457E Issued in PA
Legal business name
CENTER FOR ORTHOPAEDIC AND SPORTS MEDICINE PC
Practice address
120 Irmc Dr
Suite 160
Indiana, PA 15701-3674
Phone
(724) 465-2676
Fax
(724) 349-1830
NPI assigned
Mar 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2019

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

Authorized official

Name
Brett J Braun
Title
Chief Operating Officer
Phone
(724) 357-7234

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207XX0005X MD034457E PA Primary
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207XX0005X MD034740E PA
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207XX0005X OS008464L PA
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207XX0005X MD065847L PA
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2081P2900X MD064511L PA
PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213E00000X SC004205R PA
Physician AssistantGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363A00000X MA003136L PA
Physician AssistantGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363A00000X MA003026L PA
Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363L00000X UP006419B PA

Addresses

Primary practice location

120 Irmc Dr
Suite 160
Indiana, PA 15701-3674

Mailing address

640 Kolter Dr
Indiana, PA 15701-3570
Phone (724) 357-7196

Other practice location 1

720 W Mahoning St Ste 200
Punxsutawney, PA 15767-1351
Phone (814) 938-4447

Other practice location 2

720 W Mahoning St Ste 100
Punxsutawney, PA 15767-1351
Phone (814) 938-4447

Other practice location 3

25 Colony Blvd Ste 103
Blairsville, PA 15717-7971
Phone (724) 465-2676

Other practice location 4

321 Main St Ste 3C
Johnstown, PA 15901-1632
Phone (814) 535-6521

Other practice location 5

81 Hillcrest Dr
Punxsutawney, PA 15767-2605
Phone (814) 938-1809

Other identifiers 1

IdentifierTypeStateIssuer
1007368550004MedicaidPA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050308001019 PA Part B Supplier - Clinic/Group Practice 5890749329 Receives reassigned benefits from 22 practitioners
1 other NPI on this enrollment
Practice locations: Indiana, PA; Blairsville, PA; Punxsutawney, PA; Johnstown, PA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member organizations 5

Organizations listed as members of this organization in the National Provider Directory.

Locations

25 Colony Blvd
Ste 103
Blairsville, PA 15717
Phone (724) 465-2676

720 W Mahoning St
Ste 100
Punxsutawney, PA 15767
Phone (814) 938-0148

Practitioners & affiliated clinicians

Practitioners 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552953600000",
    "number": "1124088372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 KOLTER DR",
            "city": "INDIANA",
            "state": "PA",
            "postal_code": "157013570",
            "telephone_number": "724-357-7196",
            "fax_number": "724-357-7279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 IRMC DR",
            "address_2": "SUITE 160",
            "city": "INDIANA",
            "state": "PA",
            "postal_code": "157013674",
            "telephone_number": "724-465-2676",
            "fax_number": "724-349-1830"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "720 W Mahoning St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Punxsutawney",
            "state": "PA",
            "postal_code": "157671351",
            "country_code": "US",
            "telephone_number": "814-938-4447",
            "fax_number": "814-938-0750",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "720 W Mahoning St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Punxsutawney",
            "state": "PA",
            "postal_code": "157671351",
            "country_code": "US",
            "telephone_number": "814-938-4447",
            "fax_number": "814-938-0750",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "25 Colony Blvd Ste 103",
            "address_purpose": "LOCATION",
            "city": "Blairsville",
            "state": "PA",
            "postal_code": "157177971",
            "country_code": "US",
            "telephone_number": "724-465-2676",
            "fax_number": "724-459-1788",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "321 Main St Ste 3C",
            "address_purpose": "LOCATION",
            "city": "Johnstown",
            "state": "PA",
            "postal_code": "159011632",
            "country_code": "US",
            "telephone_number": "814-535-6521",
            "fax_number": "814-536-4819",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "81 Hillcrest Dr",
            "address_purpose": "LOCATION",
            "city": "Punxsutawney",
            "state": "PA",
            "postal_code": "157672605",
            "country_code": "US",
            "telephone_number": "814-938-1809",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CENTER FOR ORTHOPAEDIC AND SPORTS MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-23",
        "last_updated": "2019-03-19",
        "status": "A",
        "authorized_official_last_name": "BRAUN",
        "authorized_official_first_name": "BRETT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "724-357-7234"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "PA",
            "license": "MD034457E",
            "primary": true
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "PA",
            "license": "MD034740E",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "PA",
            "license": "OS008464L",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "PA",
            "license": "MD065847L",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "PA",
            "license": "MD064511L",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "PA",
            "license": "SC004205R",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA003136L",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA003026L",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "UP006419B",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007368550004",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indiana, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2019; 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.