Advanced Center for Sports & Musculoskeletal Medicine Inc
Organization Active NPI Sports Medicine (Neuromusculoskeletal Medicine) Physician · Palm Desert, CA
NPI 1376907535 · NPPES record last updated Mar 25, 2020
Key facts
- NPI
- 1376907535
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Sports Medicine (Neuromusculoskeletal Medicine) Physician 204C00000X
- License
- 20A13043 (CA)
- Legal business name
- ADVANCED CENTER FOR SPORTS & MUSCULOSKELETAL MEDICINE INC
- Practice address
- 41990 Cook St # F1006
Palm Desert, CA 92211-6100 - Phone
- (760) 636-1067
- Fax
- (760) 568-9331
- NPI assigned
- Apr 13, 2016
- Organization subpart
- No
Authorized official
- Name
- Mr. Eric Sickinger, DO
- Title
- Owner
- Phone
- (760) 636-1067
Practitioners 4
-
Eric Sickinger, D.O.
-
Joey Robert Gee, DO
-
Changhyun Kim, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161208000953 | CA | Part B Supplier - Clinic/Group Practice | 0941580906 |
Receives reassigned benefits from 3 practitioners Practice locations: Palm Desert, CA; Rancho Santa Margarita, CA; San Clemente, CA |
National Provider Directory
Locations
41990 Cook St
#F1006
Palm Desert, CA 92211
Phone (760) 568-9300
655 Camino de los Mares
Ste 305
San Clemente, CA 92673
Phone (949) 276-8090
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Neuromusculoskeletal Medicine) Physician |
204C00000X | 20A13043 | CA | Yes |
Addresses
Primary practice location
41990 Cook St # F1006
Palm Desert, CA 92211-6100
Mailing address
41990 Cook St # F1006
Palm Desert, CA 92211-6100
Phone (760) 636-1067
Other providers in Palm Desert, CA
- Adaobi Maureen Adimorah
- Adishian Dental Corporation
- Breanna Adkins-Horn
- Don Allen Adkins
- Laura Elaine Adler
- Advanced Family Health Care
- Advanced Institute of Dermatology, Inc
- Advanced Mep Systems Inc.
- Advanced Women'S Healthcare, a Medical Corporation
- Crystabel Afwireng
All providers in Palm Desert, CA · Sports Medicine (Neuromusculoskeletal Medicine) Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.