NPIMap

Organization Active NPI

Premier Orthopaedic and Sports Medicine Assoc of Southern NJ LLC

  • Orthopaedic Surgery Physician
  • Mullica Hill, NJ
National Provider Identifier
1457092611
Registry record updated Sep 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
PREMIER ORTHOPAEDIC AND SPORTS MEDICINE ASSOC OF SOUTHERN NJ LLC
Practice address
4 Burton LN Ste 300
Mullica Hill, NJ 08062-9441
Phone
(856) 690-1616
Fax
(856) 690-1089
NPI assigned
Apr 4, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2024

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: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207X00000X Primary

Addresses

Primary practice location

4 Burton LN Ste 300
Mullica Hill, NJ 08062-9441

Mailing address

352 S Delsea Dr Unit C
Vineland, NJ 08360-5308
Phone (856) 690-1616

National Provider Directory

National Provider Directory

Locations

70 Manheim Ave
Ste 1
Bridgeton, NJ 08302

Practitioners & affiliated clinicians

Practitioners 42

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

View all 42

NPI Registry JSON

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

{
    "created_epoch": "1649030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727395200000",
    "number": "1457092611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "352 S DELSEA DR UNIT C",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083605308",
            "telephone_number": "856-690-1616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 BURTON LN STE 300",
            "city": "MULLICA HILL",
            "state": "NJ",
            "postal_code": "080629441",
            "telephone_number": "856-690-1616",
            "fax_number": "856-690-1089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER ORTHOPAEDIC AND SPORTS MEDICINE ASSOC OF SOUTHERN NJ LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-04",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "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": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mullica Hill, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2024; 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.