Sportmedica, LLC

Primary specialty

Rehabilitation HospitalTaxonomy code 283X00000X

License

MD.014596 Issued in LA

Legal business name

SPORTMEDICA, LLC

Practice address

2934 Chardonnay Cir
Shreveport, LA 71106-8418

Phone

(318) 458-8490

NPI assigned

Oct 8, 2015

Organization subpart

No

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

Authorized official

Name

Mr. William Overdyke, MDNPI 1295739001

Title

Medical Physician/ Owner

Phone

(318) 458-8490

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Practitioners 1

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

• William L Overdyke, MD

  • Orthopaedic Surgery Physician
  • Shreveport, LA
  • NPI 1295739001
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1444262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444262400000",
    "number": "1124499751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2934 CHARDONNAY CIR",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711068418",
            "telephone_number": "318-458-8490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2934 CHARDONNAY CIR",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711068418",
            "telephone_number": "318-458-8490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTMEDICA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-08",
        "last_updated": "2015-10-08",
        "status": "A",
        "authorized_official_last_name": "OVERDYKE",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "MEDICAL PHYSICIAN/ OWNER",
        "authorized_official_telephone_number": "318-458-8490",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "283X00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Hospital",
            "state": "LA",
            "license": "MD.014596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shyanne Spillers
• Spinal Innovations & Rehab, LLC
• Spine Institute of Louisiana LLC
• Shonda Knox Spires, B.S., RRT-NPS, CPFT
• William V Spires, MD
• Kimberly Spotts, PA-C
• Spring Lake Surgery Center, LLC
• Springlake Alf SCC LLC
• Springlake SCC LLC
• Craig R Springmeyer, MD

• Rehabilitation Hospital in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Rehabilitation Hospital in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2015; 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.