Center for Spine & Sports Rehabilitation PC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

01037601B Issued in IN

Legal business name

CENTER FOR SPINE & SPORTS REHABILITATION PC

Practice address

3850 Shore Dr Ste 305
Indianapolis, IN 46254-4693

Phone

(317) 920-3220

Fax

(317) 920-3222

NPI assigned

Oct 17, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Thelma Lynette Green-Mack, MDNPI 1841358017

Title

President

Phone

(317) 920-3220

Specialties & licenses 1

Addresses

Other identifiers 5

Locations

Practitioners 2

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

• Thelma Lynette Green-Mack, MD

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Indianapolis, IN
  • NPI 1841358017
  NPD Authorized official
• Dianne Leach, NP

  • Physical Medicine & Rehabilitation Physician
  • Indianapolis, IN
  • NPI 1346400942
  NPD

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

{
    "created_epoch": "1192579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677024000000",
    "number": "1346439239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3850 SHORE DR STE 305",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462544693",
            "telephone_number": "317-920-3220",
            "fax_number": "317-920-3221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3850 SHORE DR STE 305",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462544693",
            "telephone_number": "317-920-3220",
            "fax_number": "317-920-3222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR SPINE & SPORTS REHABILITATION PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-17",
        "last_updated": "2023-02-22",
        "certification_date": "2023-02-22",
        "status": "A",
        "authorized_official_last_name": "GREEN-MACK",
        "authorized_official_first_name": "THELMA",
        "authorized_official_middle_name": "LYNETTE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "317-920-3220",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "IN",
            "license": "01037601B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH - COUNCIL FOR AFFORDABLE QUALITY HEALTHCARE",
            "identifier": "10815817",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI NATIONAL PROVIDER IDENTIFER GROUP",
            "identifier": "1346439239",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "250010985",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI NATIONAL PROVIDER IDENTIFER INDIVIDUAL",
            "identifier": "1841358017",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000092241",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Center for Special Surgery LLC
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• Center for Surgical Sciences & Trauma, Inc
• Center for Vein Restoration in, LLC
• Center Grove Foot & Ankle Care, P.C.
• Centerpoint Counseling
• Mary Elizabeth Centers, CRT CPFT

• Physical Medicine & Rehabilitation Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Physical Medicine & Rehabilitation Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2023; 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.