NPIMap

Organization Active NPI

Sports Medicine Associates of Augusta, LLC

  • Orthopaedic Surgery Physician
  • Augusta, GA
National Provider Identifier
1255565503
Registry record updated Apr 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
SPORTS MEDICINE ASSOCIATES OF AUGUSTA, LLC
Practice address
1706 Magnolia Way
Augusta, GA 30909-9481
Phone
(706) 210-7529
Fax
(706) 312-7608
NPI assigned
May 14, 2009
Organization subpart
Yes
Parent organization
SPORTS MEDICINE ASSOCIATES OF AUGUSTA, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 3, 2019

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

Authorized official

Name
Mrs. Patricia A. Kinney, PTNPI 1811918824
Title
Administrator
Phone
(706) 210-7529

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QS0010X
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X Primary
Orthopaedic Surgery of the Spine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XS0117X
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XX0005X
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X

Addresses

Primary practice location

1706 Magnolia Way
Augusta, GA 30909-9481

Mailing address

1706 Magnolia Way
Augusta, GA 30909-9481
Phone (706) 210-7529

Other practice location 1

211 High Gate Loop
Aiken, SC 29803-3921
Phone (803) 293-1160

Other identifiers 3

IdentifierTypeStateIssuer
CJ3550OtherSCRAILROAD MEDICARE
300034841AMedicaidGA
GPA745MedicaidSC

Other names 1

  • Champion Orthopedics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Sports Medicine Associates of Augusta2 organizations share this tax ID, including this one
Part of
Sports Medicine Associates of Augusta

Other organizations with this tax ID 1

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

Locations

211 High Gate Loop
Aiken, SC 29803
Phone (803) 265-8117

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 33

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

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1242259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554249600000",
    "number": "1255565503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1706 MAGNOLIA WAY",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309099481",
            "telephone_number": "706-210-7529",
            "fax_number": "706-312-7610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1706 MAGNOLIA WAY",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309099481",
            "telephone_number": "706-210-7529",
            "fax_number": "706-312-7608"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "211 High Gate Loop",
            "address_purpose": "LOCATION",
            "city": "Aiken",
            "state": "SC",
            "postal_code": "298033921",
            "country_code": "US",
            "telephone_number": "803-293-1160",
            "fax_number": "803-293-1130",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SPORTS MEDICINE ASSOCIATES OF AUGUSTA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPORTS MEDICINE ASSOCIATES OF AUGUSTA, LLC",
        "enumeration_date": "2009-05-14",
        "last_updated": "2019-04-03",
        "status": "A",
        "authorized_official_last_name": "KINNEY",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "706-210-7529",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family 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": "207XS0117X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CJ3550",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300034841A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GPA745",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Champion Orthopedics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Champion Orthopedics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Augusta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2019; 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.