NPIMap

Organization Active NPI

Premier Orthopaedic and Sports Medicine Associates, LTD

  • Orthopaedic Surgery Physician
  • Ridley Park, PA
National Provider Identifier
1184944167
Registry record updated Feb 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
PREMIER ORTHOPAEDIC AND SPORTS MEDICINE ASSOCIATES, LTD
Practice address
1 Bartol Ave
Ste 100
Ridley Park, PA 19078-2214
Phone
(610) 521-8970
Fax
(610) 521-3983
NPI assigned
Jun 2, 2010
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Kim Stott
Title
Administrative Manager
Phone
(610) 359-5664

Corporate family (same tax ID) 21

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

Medicare participation

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

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20100930016175 PA DME Supplier - Physician - Orthopedic/Orthopedic SurgeryDME Supplier - Physician - Hand SurgeryDME Supplier - Physician - PodiatryDME Supplier - Independently-Practicing Occupational Therapist 5890681092 Practice locations: Ridley Park, PA

National Provider Directory

National Provider Directory
Tax ID family
Premier Orthopaedics SP (71 organizations share this tax ID)

Locations

1 Bartol Ave
Ste 100
Ridley Park, PA 19078
Phone (610) 521-8970

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RS0010X
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

NPPES NPI Registry

Primary practice location

1 Bartol Ave
Ste 100
Ridley Park, PA 19078-2214

Mailing address

PO Box 5228
West Chester, PA 19380-0405
Phone (610) 359-6571

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 10, 2022.

{
    "created_epoch": "1275436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644451200000",
    "number": "1184944167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5228",
            "city": "WEST CHESTER",
            "state": "PA",
            "postal_code": "193800405",
            "telephone_number": "610-359-6571",
            "fax_number": "610-521-3983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BARTOL AVE",
            "address_2": "STE 100",
            "city": "RIDLEY PARK",
            "state": "PA",
            "postal_code": "190782214",
            "telephone_number": "610-521-8970",
            "fax_number": "610-521-3983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER ORTHOPAEDIC AND SPORTS MEDICINE ASSOCIATES, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-02",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A",
        "authorized_official_last_name": "STOTT",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "ADMINISTRATIVE MANAGER",
        "authorized_official_telephone_number": "610-359-5664"
    },
    "taxonomies": [
        {
            "code": "207RS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridley Park, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2022; 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.