Sports Medicine Institute International LLC

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

License

ME0037707 Issued in FL

Legal business name

SPORTS MEDICINE INSTITUTE INTERNATIONAL LLC

Practice address

1925 Don Wickham Dr
Clermont, FL 34711-1915

Phone

(352) 243-9700

Fax

(352) 243-5795

NPI assigned

Jul 17, 2013

Last updated

Dec 10, 2013By 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

Tracee Leiann Ray, RN

Title

President

Phone

(352) 243-9700

Specialties & licenses 1

Addresses

Interoperability endpoints

• FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.400285

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

{
    "created_epoch": "1374019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386633600000",
    "number": "1366884496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 DON WICKHAM DR",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347111915",
            "telephone_number": "352-243-9700",
            "fax_number": "352-243-5795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 DON WICKHAM DR",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347111915",
            "telephone_number": "352-243-9700",
            "fax_number": "352-243-5795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTS MEDICINE INSTITUTE INTERNATIONAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-17",
        "last_updated": "2013-12-10",
        "status": "A",
        "authorized_official_last_name": "RAY",
        "authorized_official_first_name": "TRACEE",
        "authorized_official_middle_name": "LEIANN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "352-243-9700",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "FL",
            "license": "ME0037707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sports Medicine (Orthopaedic Surgery) Physician in Clermont, FL
• Providers in Clermont, FL by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2013; 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.