NPIMap

Organization Active NPI

Beach Orthopaedic & Sports Medicine Clinic, PA

  • Orthopaedic Surgery Physician
  • Fort Walton Beach, FL
National Provider Identifier
1295769263
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
ME94278 Issued in FL
Legal business name
BEACH ORTHOPAEDIC & SPORTS MEDICINE CLINIC, PA
Practice address
1032 Mar Walt Dr
Suite 210
Fort Walton Beach, FL 32547-6645
Phone
(850) 664-5633
Fax
(850) 315-2664
NPI assigned
Jul 10, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Samuel William Capra Jr., MDNPI 1477508604
Title
President/Owner
Phone
(850) 664-5633

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X ME94278 FL Primary

Addresses

Primary practice location

1032 Mar Walt Dr
Suite 210
Fort Walton Beach, FL 32547-6645

Mailing address

1032 Mar Walt Dr
Suite 210
Fort Walton Beach, FL 32547-6645
Phone (850) 664-5633

National Provider Directory

National Provider Directory

Locations

1032 Mar Walt Dr
Unit 210
Fort Walton Beach, FL 32547
Phone (850) 664-5633

Practitioners & affiliated clinicians

Practitioners 10

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": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295769263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1032 MAR WALT DR",
            "address_2": "SUITE 210",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476645",
            "telephone_number": "850-664-5633",
            "fax_number": "850-315-2664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1032 MAR WALT DR",
            "address_2": "SUITE 210",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476645",
            "telephone_number": "850-664-5633",
            "fax_number": "850-315-2664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACH ORTHOPAEDIC & SPORTS MEDICINE CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CAPRA",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "850-664-5633",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "FL",
            "license": "ME94278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Walton Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.