Sport Central Osteopathic, a Medical Corporation

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

G72600 Issued in CA

Legal business name

SPORT CENTRAL OSTEOPATHIC, A MEDICAL CORPORATION

Practice address

8879 Laurel Canyon Blvd
Suite C
Sun Valley, CA 91352-2959

Phone

(818) 252-2000

Fax

(818) 252-6896

NPI assigned

Nov 3, 2009

Organization subpart

No

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

Authorized official

Name

Paul M Robinson, MD

Title

Director

Phone

(818) 955-5112

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Sport-Central Healthcare Doing business as

Practitioners 2

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

• Ruth Suzanne Fontaine, M.D., M.A.

  • General Practice Physician
  • Sun Valley, CA
  • NPI 1144384066
  NPD (past)
• John V Watkins, M.D.

  • Pain Medicine (Anesthesiology) Physician
  • Albuquerque, NM
  • NPI 1851367718
  NPD (past)

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

{
    "created_epoch": "1257206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269648000000",
    "number": "1144557729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14069 MARQUESAS WAY",
            "address_2": "SUITE 216D",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926052",
            "telephone_number": "310-301-3031",
            "fax_number": "310-301-3001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8879 LAUREL CANYON BLVD",
            "address_2": "SUITE C",
            "city": "SUN VALLEY",
            "state": "CA",
            "postal_code": "913522959",
            "telephone_number": "818-252-2000",
            "fax_number": "818-252-6896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORT CENTRAL OSTEOPATHIC, A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-03",
        "last_updated": "2010-03-27",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "818-955-5112",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "G72600",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "G72600",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "00G726000",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sport-Central Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ashley Alexandria Simpson
• Calvert Sims
• Rebecca Small, LCSW
• Morgan Southard
• Special Choice Hospice Inc
• St Medical Group
• Rebecca Stapornkul, OD
• Star Medical Laboratory Inc
• Starco Trans Inc.
• Vazgen Stepanosyan, MD

• Physical Medicine & Rehabilitation Physician in Sun Valley, CA
• Providers in Sun Valley, CA by specialty
• Physical Medicine & Rehabilitation Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2010; 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.