The Desert Sports Medicine and Shoulder Clinic LLC

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

31646 Issued in AZ

Legal business name

THE DESERT SPORTS MEDICINE AND SHOULDER CLINIC LLC

Practice address

6130 E Brown Rd
Mesa, AZ 85205-4960

Phone

(480) 807-3554

Fax

(480) 807-8330

NPI assigned

Mar 27, 2008

Organization subpart

No

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

Authorized official

Name

Mr. David Philip Richards, MD

Title

President/Physician

Phone

(480) 807-3554

Specialties & licenses 2

Addresses

Practitioners 1

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.

• Douglas A Clark, MD

  • Orthopaedic Surgery Physician
  • Tempe, AZ
  • NPI 1396892907
  NPD

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

{
    "created_epoch": "1206576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1235301466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6130 EAST BROWN ROAD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852054960",
            "telephone_number": "480-807-3554",
            "fax_number": "480-807-8330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6130 E BROWN RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852054960",
            "telephone_number": "480-807-3554",
            "fax_number": "480-807-8330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DESERT SPORTS MEDICINE AND SHOULDER CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-27",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "RICHARDS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "PHILIP",
        "authorized_official_title_or_position": "PRESIDENT/PHYSICIAN",
        "authorized_official_telephone_number": "480-807-3554",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "AZ",
            "license": "31646",
            "primary": true
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "AZ",
            "license": "31646",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• The Evangelical Lutheran Good Samaritan Society (The Gables)
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• The First Step Az LLC (The First Step AZ)

• Orthopaedic Surgery Physician in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Orthopaedic Surgery Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; 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.