Active NPI
Modern Sports Medicine LLC
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- Tempe, AZ
National Provider Identifier
1568072387
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- Legal business name
- MODERN SPORTS MEDICINE LLC
- Practice address
- 1840 E Warner Rd Ste 121
Tempe, AZ 85284-3445 - Phone
- (480) 878-4806
- Fax
- (480) 840-1672
- NPI assigned
- Aug 6, 2020
- Last updated
- Sep 26, 2024
- 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
- Joshua Adams
- Title
- Director of Revenue
- Phone
- (480) 306-6627
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Physical Medicine & Rehabilitation) Physician | 2081S0010X | Primary | ||
| Physical Therapist | 225100000X | |||
| Sports Physical Therapist | 2251S0007X | |||
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Medical Physician Assistant | 363AM0700X |
Addresses
Primary practice location
1840 E Warner Rd Ste 121
Tempe, AZ 85284-3445
Mailing address
1840 E Warner Rd Ste 121
Tempe, AZ 85284-3445
Phone (480) 878-4806
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1596672000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1727308800000",
"number": "1568072387",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1840 E WARNER RD STE 121",
"city": "TEMPE",
"state": "AZ",
"postal_code": "852843445",
"telephone_number": "480-878-4806",
"fax_number": "480-840-1672"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1840 E WARNER RD STE 121",
"city": "TEMPE",
"state": "AZ",
"postal_code": "852843445",
"telephone_number": "480-878-4806",
"fax_number": "480-840-1672"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MODERN SPORTS MEDICINE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-08-06",
"last_updated": "2024-09-26",
"certification_date": "2024-09-26",
"status": "A",
"authorized_official_last_name": "ADAMS",
"authorized_official_first_name": "JOSHUA",
"authorized_official_title_or_position": "DIRECTOR OF REVENUE",
"authorized_official_telephone_number": "480-306-6627"
},
"taxonomies": [
{
"code": "2081S0010X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Medicine & Rehabilitation, Sports Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "2251S0007X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Therapist, Sports",
"state": null,
"license": null,
"primary": false
},
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physician Assistant, Medical",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Tempe, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 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.