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Organization Active NPI

Premier Orthopaedic and Sports Medicine Assoc of Southern NJ LLC

  • Orthopaedic Surgery Physician
  • Vineland, NJ
National Provider Identifier
1396812574
Registry record updated Apr 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
MA63862 Issued in NJ
Legal business name
PREMIER ORTHOPAEDIC AND SPORTS MEDICINE ASSOC OF SOUTHERN NJ LLC
Practice address
352 S Delsea Dr Ste C
Vineland, NJ 08360-5306
Phone
(856) 690-1616
Fax
(856) 690-1089
NPI assigned
Nov 30, 2006
Last updated
Apr 29, 2020By the provider in NPPES
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 M Shepherd
Title
Administrator of Physician Services
Phone
(856) 690-1616

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X MA63862 NJ Primary

Addresses

Primary practice location

352 S Delsea Dr Ste C
Vineland, NJ 08360-5306

Mailing address

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

Other practice location 1

298 S Delsea Dr
Vineland, NJ 08360-4568
Phone (856) 690-1616

Other practice location 2

556 Egg Harbor Rd Ste A
Sewell, NJ 08080-2326
Phone (856) 690-1616

Other practice location 3

1004 Haddonfield Rd
Cherry Hill, NJ 08002-2746
Phone (856) 690-1616

Other practice location 4

698 Mullica Hill Rd Ste 150
Mullica Hill, NJ 08062-4454
Phone (856) 690-1616

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051031000150 NJ Part B Supplier - Clinic/Group Practice 1557388436 Receives reassigned benefits from 43 practitioners
Practice locations: Mullica Hill, NJ; West Deptford, NJ; Vineland, NJ; Sewell, NJ; Cherry Hill, NJ; Elmer, NJ
O20180809004403 NJ DME Supplier - Physician - General Practice 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

Locations

1450 Almonesson Rd
Ste 155
Deptford, NJ 08096

4 Burton Ln
Mullica Hill, NJ 08062

Practitioners & affiliated clinicians

Practitioners 45

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.

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588118400000",
    "number": "1396812574",
    "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": "352 S DELSEA DR STE C",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083605306",
            "telephone_number": "856-690-1616",
            "fax_number": "856-690-1089"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "298 S Delsea Dr",
            "address_purpose": "LOCATION",
            "city": "Vineland",
            "state": "NJ",
            "postal_code": "083604568",
            "country_code": "US",
            "telephone_number": "856-690-1616",
            "fax_number": "856-690-1089",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "556 Egg Harbor Rd Ste A",
            "address_purpose": "LOCATION",
            "city": "Sewell",
            "state": "NJ",
            "postal_code": "080802326",
            "country_code": "US",
            "telephone_number": "856-690-1616",
            "fax_number": "856-690-1089",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1004 Haddonfield Rd",
            "address_purpose": "LOCATION",
            "city": "Cherry Hill",
            "state": "NJ",
            "postal_code": "080022746",
            "country_code": "US",
            "telephone_number": "856-690-1616",
            "fax_number": "856-690-1089",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "698 Mullica Hill Rd Ste 150",
            "address_purpose": "LOCATION",
            "city": "Mullica Hill",
            "state": "NJ",
            "postal_code": "080624454",
            "country_code": "US",
            "telephone_number": "856-690-1616",
            "fax_number": "856-690-1089",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PREMIER ORTHOPAEDIC AND SPORTS MEDICINE ASSOC OF SOUTHERN NJ LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2020-04-29",
        "certification_date": "2020-04-29",
        "status": "A",
        "authorized_official_last_name": "SHEPHERD",
        "authorized_official_first_name": "VERNA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR OF PHYSICIAN SERVICES",
        "authorized_official_telephone_number": "856-690-1616"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NJ",
            "license": "MA63862",
            "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.