NPIMap

Organization Active NPI

Performance Spine & Sports Specialists, PA

  • Physical Medicine & Rehabilitation Physician
  • Greensboro, NC
National Provider Identifier
1477982833
Registry record updated Nov 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
2007-00213 Issued in NC
Legal business name
PERFORMANCE SPINE & SPORTS SPECIALISTS, PA
Practice address
1507 Westover Ter
Suite B
Greensboro, NC 27408-7130
Phone
(336) 501-3796
Fax
(336) 333-5477
NPI assigned
Nov 6, 2013
Last updated
Nov 10, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2014

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

Authorized official

Name
Mrs. Gail Revis
Title
Office Manager
Phone
(336) 501-3796

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 2007-00213 NC Primary

Addresses

Primary practice location

1507 Westover Ter
Suite B
Greensboro, NC 27408-7130

Mailing address

1507 Westover Ter
Suite B
Greensboro, NC 27408-7130
Phone (336) 501-3796

National Provider Directory

National Provider Directory

Locations

1507 Westover Ter
Ste B
Greensboro, NC 27408
Phone (336) 501-3796

Practitioners & affiliated clinicians

Practitioners 2

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": "1383696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415577600000",
    "number": "1477982833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1507 WESTOVER TER",
            "address_2": "SUITE B",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274087130",
            "telephone_number": "336-501-3796",
            "fax_number": "336-333-5477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1507 WESTOVER TER",
            "address_2": "SUITE B",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274087130",
            "telephone_number": "336-501-3796",
            "fax_number": "336-333-5477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFORMANCE SPINE & SPORTS SPECIALISTS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-06",
        "last_updated": "2014-11-10",
        "status": "A",
        "authorized_official_last_name": "REVIS",
        "authorized_official_first_name": "GAIL",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "336-501-3796",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NC",
            "license": "2007-00213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2014; 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.