NPIMap

Organization Active NPI

Orthopedics & Sports Medicine LLC

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Las Vegas, NV
National Provider Identifier
1265419014
Registry record updated Dec 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
Legal business name
ORTHOPEDICS & SPORTS MEDICINE LLC
Practice address
9499 W Charleston Blvd
Ste 200
Las Vegas, NV 89117-7147
Phone
(702) 933-9393
Fax
(702) 933-6789
NPI assigned
Dec 22, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2025

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

Authorized official

Name
Carmelina Simon
Title
Business Office Manager
Phone
(702) 933-9393

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XX0005X Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X

Addresses

Primary practice location

9499 W Charleston Blvd
Ste 200
Las Vegas, NV 89117-7147

Mailing address

PO Box 97618
Las Vegas, NV 89193-7618
Phone (702) 933-9393

Other names 1

  • Knee and Shoulder Institute Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040427001203 NV Part B Supplier - Clinic/Group Practice 4082601570 Receives reassigned benefits from 8 practitioners
Practice locations: Las Vegas, NV

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Tax ID family
Steven C Thomas MD Limi2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

9499 W Charleston Blvd
Las Vegas, NV 89117
Phone (702) 228-5477

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1135209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764633600000",
    "number": "1265419014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 97618",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891937618",
            "telephone_number": "702-933-9393",
            "fax_number": "702-933-6789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9499 W CHARLESTON BLVD",
            "address_2": "STE 200",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891177147",
            "telephone_number": "702-933-9393",
            "fax_number": "702-933-6789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPEDICS & SPORTS MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-22",
        "last_updated": "2025-12-02",
        "certification_date": "2025-12-02",
        "status": "A",
        "authorized_official_last_name": "SIMON",
        "authorized_official_first_name": "CARMELINA",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "702-933-9393"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Knee and Shoulder Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2025; 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.