Boston Sports & Spine LLC

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

Legal business name

BOSTON SPORTS & SPINE LLC

Practice address

20 Walnut St Ste 14
Wellesley, MA 02481-2104

Phone

(781) 591-7855

NPI assigned

Jan 24, 2024

Organization subpart

No

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

Authorized official

Name

Walter Sussman, DONPI 1538457684

Title

Owner

Phone

(781) 591-7855

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Locations

Practitioners 4

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

• Walter Sussman, D.O.

  • Physical Medicine & Rehabilitation Physician
  • Wellesley, MA
  • NPI 1538457684
  Medicare reassignment Care Compare group Authorized official
• Carrie O'Regan, PA-C

  • Physician Assistant
  • Wellesley, MA
  • NPI 1982019873
  Medicare reassignment Care Compare group NPD
• Erek W Latzka, MD, RMSK

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Wellesley, MA
  • NPI 1336587385
  Medicare reassignment Care Compare group
• Nicholas Tsitsilianos, MD

  • Physical Medicine & Rehabilitation Physician
  • Worcester, MA
  • NPI 1386200780
  Medicare reassignment

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

{
    "created_epoch": "1706054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706054400000",
    "number": "1407618648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 UNITED DR STE 102",
            "city": "WEST BRIDGEWATER",
            "state": "MA",
            "postal_code": "023791056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 WALNUT ST STE 14",
            "city": "WELLESLEY",
            "state": "MA",
            "postal_code": "024812104",
            "telephone_number": "781-591-7855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSTON SPORTS & SPINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-24",
        "last_updated": "2024-01-24",
        "certification_date": "2024-01-24",
        "status": "A",
        "authorized_official_last_name": "SUSSMAN",
        "authorized_official_first_name": "WALTER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "781-591-7855",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Boston Pelvic Health and Wellness PC
• Boston Private Nursing LLC
• Boston Retina, PLLC
• Boston Sos
• Boston Sports & Biologics PC
• Boston Urogyn
• Boston Urogyn
• Bostonian Transportation Services Inc
• Paul Bottom, M.S CCC-SLP
• Andrew J. Bouley, M.D.

• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Wellesley, MA
• Providers in Wellesley, MA by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2024; 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.