Pro Sports Institute a Medical Corporation Inc

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

License

65423 Issued in CA

Legal business name

PRO SPORTS INSTITUTE A MEDICAL CORPORATION INC

Practice address

7677 Center Ave
Suite 403
Huntington Beach, CA 92647-3074

Phone

(714) 379-9355

Fax

(714) 379-5402

NPI assigned

Oct 24, 2016

Last updated

Oct 24, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Derek Tan Dee, MD

Title

President

Phone

(310) 408-5345

Specialties & licenses 2

Addresses

Locations

Practitioners 1

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.

• Richard Milton Liebel, D.C.

  • Chiropractor
  • Huntington Beach, CA
  • NPI 1225148661
  NPD (past)

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

{
    "created_epoch": "1477267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477267200000",
    "number": "1568913671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7677 CENTER AVE",
            "address_2": "SUITE 403",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926473074",
            "telephone_number": "714-379-9355",
            "fax_number": "714-379-5402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7677 CENTER AVE",
            "address_2": "SUITE 403",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926473074",
            "telephone_number": "714-379-9355",
            "fax_number": "714-379-5402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO SPORTS INSTITUTE A MEDICAL CORPORATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-24",
        "last_updated": "2016-10-24",
        "status": "A",
        "authorized_official_last_name": "DEE",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "TAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-408-5345",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "23165",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "CA",
            "license": "65423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jerry Julian Jerome Primm, CADC I
• Danielle Princi
• Priority Rehabilitation, Inc.
• Private Medical Consulting (David R. Bloom M.D.)
• Pro Ivy Medical Group PC
• Proactive Care Nursing, Inc
• Proactive Nursing, Inc.
• Procare Work Injury Center & Urgent Care
• Terese C. Proctor, RD
• Prodius, Inc.

• Sports Medicine (Orthopaedic Surgery) Physician in Huntington Beach, CA
• Providers in Huntington Beach, CA by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2016; 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.