Active NPI
Muskingum University
Doing business as Muskingum Sports Medicine
- General Practice Physician
- New Concord, OH
National Provider Identifier
1568029205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- Legal business name
- MUSKINGUM UNIVERSITY
- Doing business as
- Muskingum Sports Medicine
- Practice address
- 163 Stormont St
New Concord, OH 43762-1118 - Phone
- (740) 826-8211
- NPI assigned
- May 28, 2019
- Last updated
- Dec 17, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mouzon Bass III
- Title
- Administrator/Agent
- Phone
- (972) 367-4845
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | Primary |
Addresses
Primary practice location
163 Stormont St
New Concord, OH 43762-1118
Mailing address
15305 Dallas Pkwy Ste 800
Addison, TX 75001-6415
Phone (972) 367-4845
Other names 1
- Muskingum Sports Medicine
National Provider Directory
National Provider Directory- Tax ID family
- Muskingum Health Center
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Muskingum Health Center
- Family Medicine Physician
- New Concord, OH
- NPI 1316616188
Locations
163 Stormont St
New Concord, OH 43762
Phone (740) 826-8211
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.
-
- Athletic Trainer
- New Concord, OH
- NPI 1205325321
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559001600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1639699200000",
"number": "1568029205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15305 DALLAS PKWY STE 800",
"city": "ADDISON",
"state": "TX",
"postal_code": "750016415",
"telephone_number": "972-367-4845"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "163 STORMONT ST",
"city": "NEW CONCORD",
"state": "OH",
"postal_code": "437621118",
"telephone_number": "740-826-8211"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MUSKINGUM UNIVERSITY",
"organizational_subpart": "NO",
"enumeration_date": "2019-05-28",
"last_updated": "2021-12-17",
"certification_date": "2021-12-17",
"status": "A",
"authorized_official_last_name": "BASS",
"authorized_official_first_name": "MOUZON",
"authorized_official_title_or_position": "ADMINISTRATOR/AGENT",
"authorized_official_telephone_number": "972-367-4845",
"authorized_official_name_suffix": "III"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "General Practice",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Muskingum Sports Medicine",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Muskingum Sports Medicine",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in New Concord, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.