NPIMap

Organization Active NPI

Spine Transformation LLC

  • Orthopaedic Surgery of the Spine Physician
  • Ardmore, OK
National Provider Identifier
1215192265
Registry record updated Nov 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X
License
4546 Issued in OK
Legal business name
SPINE TRANSFORMATION LLC
Practice address
915 10TH Ave NW
Ardmore, OK 73401-4025
Phone
(580) 223-7200
Fax
(580) 223-7207
NPI assigned
Jul 18, 2008
Last updated
Nov 10, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2010

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

Authorized official

Name
Dereck Aaron Peery, DONPI 1164543203
Title
President/Owner
Phone
(580) 223-7200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery of the Spine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207XS0117X 4546 OK Primary

Addresses

Primary practice location

915 10TH Ave NW
Ardmore, OK 73401-4025

Mailing address

915 10TH Ave NW
Ardmore, OK 73401-4025
Phone (580) 223-7200

Other identifiers 1

IdentifierTypeStateIssuer
200204540AMedicaidOK

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1216339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289347200000",
    "number": "1215192265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 10TH AVE NW",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734014025",
            "telephone_number": "580-223-7200",
            "fax_number": "580-223-7207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 10TH AVE NW",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734014025",
            "telephone_number": "580-223-7200",
            "fax_number": "580-223-7207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE TRANSFORMATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-18",
        "last_updated": "2010-11-10",
        "status": "A",
        "authorized_official_last_name": "PEERY",
        "authorized_official_first_name": "DERECK",
        "authorized_official_middle_name": "AARON",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "580-223-7200",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "OK",
            "license": "4546",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200204540A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ardmore, OK

Sources for this page

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