NPIMap

Organization Active NPI

Sports Medicine Associates of San Antonio, PA

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Boerne, TX
National Provider Identifier
1124823059
Registry record updated Feb 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
Legal business name
SPORTS MEDICINE ASSOCIATES OF SAN ANTONIO, PA
Practice address
112 Herff Rd Ste 300
Boerne, TX 78006-2750
Phone
(210) 699-8326
NPI assigned
Feb 14, 2025
Last updated
Feb 14, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2025

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

Authorized official

Name
Julie Birkelo
Title
Credentialing Specialist
Phone
(210) 756-5240

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Orthopaedic Surgery Physician 207X00000X NU
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X NU Primary

Addresses

Primary practice location

112 Herff Rd Ste 300
Boerne, TX 78006-2750

Mailing address

PO Box 268996
Dept 1131
Oklahoma City, OK 73126
Phone (210) 699-8326

National Provider Directory

National Provider Directory
Tax ID family
Sports Medicine Associates of San Antonio9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1739491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739491200000",
    "number": "1124823059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 268996",
            "address_2": "DEPT 1131",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "73126",
            "telephone_number": "210-699-8326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 HERFF RD STE 300",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "780062750",
            "telephone_number": "210-699-8326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTS MEDICINE ASSOCIATES OF SAN ANTONIO, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-14",
        "last_updated": "2025-02-14",
        "certification_date": "2025-02-14",
        "status": "A",
        "authorized_official_last_name": "BIRKELO",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "210-756-5240"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boerne, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2025; 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.