Premiere Spine and Sports Medicine LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

PREMIERE SPINE AND SPORTS MEDICINE LLC

Practice address

13114 Pennsylvania Ave
Hagerstown, MD 21742-2741

Phone

(301) 800-7770

NPI assigned

Jun 15, 2017

Last updated

Nov 21, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Christopher David Clark, MDNPI 1215257217

Title

Owner/Physician

Phone

(252) 295-8685

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/16159/brand/1/csg/1/fhir/r4
• FHIR API: https://fhir4.healow.com/fhir/r4/IGCDDD

Practitioners 6

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.

• Christopher David Clark, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Hagerstown, MD
  • NPI 1215257217
  Medicare reassignment Care Compare group NPD Authorized official
• Rebecca Nicole Moore, PT, DPT

  • Physical Therapist
  • Hagerstown, MD
  • NPI 1174294805
  Medicare reassignment Care Compare group NPD
• Emily E Oliver, PT

  • Orthopedic Physical Therapist
  • Hagerstown, MD
  • NPI 1275016925

  Physical Medicine & Rehabilitation

  Medicare reassignment Care Compare group NPD
• Danielle Pavlyn Dobbins, PA-C, MMS

  • Medical Physician Assistant
  • Hagerstown, MD
  • NPI 1467650671
  Medicare reassignment Care Compare group
• Stephanie R Mabie, PA-C

  • Physician Assistant
  • Martinsburg, WV
  • NPI 1659711679

  MD

  Medicare reassignment NPD
• Sarah Taylor Lincoln, PA-C

  • Physician Assistant
  • Hagerstown, MD
  • NPI 1760613541
  Medicare reassignment

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

{
    "created_epoch": "1497484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732147200000",
    "number": "1245760875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13114 PENNSYLVANIA AVE",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217423720",
            "telephone_number": "301-800-7770",
            "fax_number": "301-800-7891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13114 PENNSYLVANIA AVE",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217422741",
            "telephone_number": "301-800-7770"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1165 Imperial Dr",
            "address_purpose": "LOCATION",
            "city": "Hagerstown",
            "state": "MD",
            "postal_code": "217406555",
            "country_code": "US",
            "telephone_number": "301-800-7770",
            "fax_number": "301-800-7891",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PREMIERE SPINE AND SPORTS MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-15",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "252-295-8685",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "659938900",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Powerback Rehabilitation LLC
• Michelle Poye-Seal, LCSW-C
• Cassandra Lynn Prasad, NP
• Richard Bain Prather III, D.D.S.
• Preetinder Kaur Aulakh DDS LLC (Dentistry @ Hagerstown)
• Premiere Spine and Sports Medicine LLC
• Premise Health of Maryland Medical P C (Family First Medical Center and Pharmacy)
• Premium Services, Inc
• William Prescott, MD
• Kathleen Prest, LMSW

• Physical Medicine & Rehabilitation Physician in Hagerstown, MD
• Providers in Hagerstown, MD by specialty
• Physical Medicine & Rehabilitation Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2024; 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.