NPIMap

Organization Active NPI

Premier Orthopaedic & Sports Medicine Assoc of Southern NJ LLC

  • Orthopaedic Surgery Physician
  • Vineland, NJ
National Provider Identifier
1376164400
Registry record updated Apr 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
PREMIER ORTHOPAEDIC & SPORTS MEDICINE ASSOC OF SOUTHERN NJ LLC
Practice address
298 S Delsea Dr
Vineland, NJ 08360-4568
Phone
(856) 690-1616
Fax
(856) 690-1089
NPI assigned
Apr 29, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2020

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

Authorized official

Name
Verna Shepherd
Title
Administrator of Physician Services
Phone
(856) 690-1616

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X Primary

Addresses

Primary practice location

298 S Delsea Dr
Vineland, NJ 08360-4568

Mailing address

352 S Delsea Dr Ste C
Vineland, NJ 08360-5306
Phone (856) 690-1616

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200616003231 NJ DME Supplier - Physician - General PracticeDME Supplier - Sports Medicine 1557388436 Practice locations: Vineland, NJ

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Premier Orthopaedic and Sports Medicine Assoc of Southern NJ LLC2 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.

NPI Registry JSON

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

{
    "created_epoch": "1588118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588118400000",
    "number": "1376164400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "352 S DELSEA DR STE C",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083605306",
            "telephone_number": "856-690-1616",
            "fax_number": "856-690-1089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "298 S DELSEA DR",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083604568",
            "telephone_number": "856-690-1616",
            "fax_number": "856-690-1089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER ORTHOPAEDIC & SPORTS MEDICINE ASSOC OF SOUTHERN NJ LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-29",
        "last_updated": "2020-04-29",
        "certification_date": "2020-04-29",
        "status": "A",
        "authorized_official_last_name": "SHEPHERD",
        "authorized_official_first_name": "VERNA",
        "authorized_official_title_or_position": "ADMINISTRATOR OF PHYSICIAN SERVICES",
        "authorized_official_telephone_number": "856-690-1616"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vineland, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2020; 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.