Sports Healthcare Centers, Inc.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

615540000 Issued in TX

Legal business name

SPORTS HEALTHCARE CENTERS, INC.

Doing business as

dba North Texas Sports Medicine

Practice address

2800 S FM 51
Ste B
Decatur, TX 76234-4002

Phone

(940) 627-7532

Fax

(940) 627-7547

NPI assigned

Oct 3, 2006

Organization subpart

No

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

Authorized official

Name

Dale Roth RodgersNPI 1952630469

Title

President

Phone

(940) 627-7532

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• dba North Texas Sports Medicine Doing business as

Medicare fee-for-service enrollment

Enrolled in TX2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1548355183. Details of each certification follow.

• CCN 456779 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 456779

Legal name

NORTH TEXAS SPORTS MEDICINE

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Oct 28, 1996

Last certification

Aug 15, 2016

Ownership / control type

State Government

Facility address

2800 South FM 51 Ste B
Decatur, TX 76234

Locations

Practitioners 4

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.

• Corinna Rene Baffa, PT

  • Physical Therapist
  • Decatur, TX
  • NPI 1831212620
  Medicare reassignment NPD
• Dale Roth Rodgers, ATC/LAT

  • Athletic Trainer
  • Decatur, TX
  • NPI 1952630469
  NPD Authorized official
• Andrea Rodrigues Carvalho, MPT

  • Physical Therapist
  • Decatur, TX
  • NPI 1881789089
  NPD (past)
• Dee Cornell, PT ATC

  • Physical Therapist
  • Decatur, TX
  • NPI 1902997067
  NPD (past)

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341532800000",
    "number": "1548355183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1267",
            "city": "DECATUR",
            "state": "TX",
            "postal_code": "762344002",
            "telephone_number": "940-627-7532",
            "fax_number": "940-627-7547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 S FM 51",
            "address_2": "STE B",
            "city": "DECATUR",
            "state": "TX",
            "postal_code": "762344002",
            "telephone_number": "940-627-7532",
            "fax_number": "940-627-7547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTS HEALTHCARE CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2012-07-06",
        "status": "A",
        "authorized_official_last_name": "RODGERS",
        "authorized_official_first_name": "DALE",
        "authorized_official_middle_name": "ROTH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "940-627-7532"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "615540000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0217143-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "dba North Texas Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Heather Nicole Stark, FNP-C
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• Jori Steele
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• Physical Therapist in Decatur, TX
• Providers in Decatur, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.