NPIMap

Organization Active NPI

South Bay Orthopedic and Sports Medicine Clinic, Inc.

  • Sports Medicine (Orthopaedic Surgery) Physician
  • San Jose, CA
National Provider Identifier
1467548297
Registry record updated Jan 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
H27947 Issued in CA
Legal business name
SOUTH BAY ORTHOPEDIC AND SPORTS MEDICINE CLINIC, INC.
Practice address
333 Oconnor Dr
San Jose, CA 95128-1623
Phone
(408) 376-3380
NPI assigned
Oct 5, 2006
Last updated
Jan 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2023

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

Authorized official

Name
Dr. Samir Sharma, M.D.NPI 1508966508
Title
Owner
Phone
(408) 376-3380

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X H27947 CA Primary
Physical Medicine & Rehabilitation Physician 208100000X A85279 CA

Addresses

Primary practice location

333 Oconnor Dr
San Jose, CA 95128-1623

Mailing address

2386 Bentley Ridge Dr
San Jose, CA 95138-2435
Phone (530) 294-1136

Other practice location 1

221 E Hacienda Ave
Suite D
Campbell, CA 95008-6625
Phone (408) 376-3380

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081013000066 CA Part B Supplier - Clinic/Group Practice 6901974351 Receives reassigned benefits from 6 practitioners
Practice locations: San Jose, CA

National Provider Directory

National Provider Directory

Locations

221 E Hacienda Ave
Ste D
Campbell, CA 95008
Phone 4083564959200

14651 S Bascom Ave
#280
Los Gatos, CA 95032
Phone (408) 356-0444

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674000000000",
    "number": "1467548297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2386 BENTLEY RIDGE DR",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951382435",
            "telephone_number": "530-294-1136",
            "fax_number": "530-294-1143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 OCONNOR DR",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951281623",
            "telephone_number": "408-376-3380"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "221 E Hacienda Ave",
            "address_2": "Suite D",
            "address_purpose": "LOCATION",
            "city": "Campbell",
            "state": "CA",
            "postal_code": "950086625",
            "country_code": "US",
            "telephone_number": "408-376-3380",
            "fax_number": "408-376-3801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTH BAY ORTHOPEDIC AND SPORTS MEDICINE CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2023-01-18",
        "certification_date": "2023-01-18",
        "status": "A",
        "authorized_official_last_name": "SHARMA",
        "authorized_official_first_name": "SAMIR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "408-376-3380",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "CA",
            "license": "H27947",
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "A85279",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2023; 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.