Head Sport Em LLC

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

Legal business name

HEAD SPORT EM LLC

Practice address

980 W Ironwood Dr Ste 206
Coeur D Alene, ID 83814-2668

Phone

(208) 512-4334

NPI assigned

Nov 1, 2023

Organization subpart

No

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

Authorized official

Name

Craig Panos, MDNPI 1104855188

Title

Owner

Phone

(208) 512-4334

Specialties & licenses 1

Addresses

Other names 1

• Head Spine Sport Doing business as

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Practitioners 1

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

• Craig James Panos, M. D.

  • Family Medicine Physician
  • Coeur D Alene, ID
  • NPI 1104855188
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1698796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698796800000",
    "number": "1194598102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "980 W IRONWOOD DR STE 206",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "980 W IRONWOOD DR STE 206",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142668",
            "telephone_number": "208-512-4334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEAD SPORT EM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-01",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A",
        "authorized_official_last_name": "PANOS",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-512-4334",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Head Spine Sport",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Zoe Rae Hayhurst
• McKenna Hays
• Melodie R Hays, PA-C
• Margaret S. Haywood, LPC
• Tiffany Hazen
• Travis Charles Headley, PA
• Healing Hearts Mental Health Therapy
• Healing Restorations PLLC
• Healing Through Connections LLC
• Health Sport LLC

• Sports Medicine (Family Medicine) Physician in Coeur D Alene, ID
• Providers in Coeur D Alene, ID by specialty
• Sports Medicine (Family Medicine) Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2023; 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.