NPIMap

Organization Active NPI

Sportsmed PT of Connecticut PLLC

Doing business as SportsMed Physical Therapy

  • Physical Therapist
  • Bridgeport, CT
National Provider Identifier
1609441534
Registry record updated May 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
SPORTSMED PT OF CONNECTICUT PLLC
Doing business as
SportsMed Physical Therapy
Practice address
4775 Main St
Bridgeport, CT 06606-1877
Phone
(201) 345-5905
NPI assigned
May 24, 2021
Last updated
May 24, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2021

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

Authorized official

Name
Carol Azar, RN, BSN
Title
VP of RCM
Phone
(201) 857-0527

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X NU
Acupuncturist 171100000X NU
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

4775 Main St
Bridgeport, CT 06606-1877

Mailing address

266 Harristown Rd Ste 304
Glen Rock, NJ 07452-3321
Phone (201) 345-5905

Other names 1

  • SportsMed Physical Therapy Doing business as

Electronic endpoints 3

TypeEndpointUseAffiliation
Other URL www.spineandsportsmed.com SportsMed PT LLC
Other URL www.spineandsportsmed.com SportsMed PT LLC
Other URL www.spineandsportsmed.com SportsMed PT LLC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211123000473 CT Part B Supplier - Clinic/Group Practice 5395134852 Receives reassigned benefits from 13 practitioners
Practice locations: West Haven, CT; Stamford, CT; Hamden, CT; Norwalk, CT; Bridgeport, CT

National Provider Directory

National Provider Directory
Tax ID family
Sportsmed PT of CT PLLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

804 E Main St
Stamford, CT 06902
Phone (203) 443-8778

764 Campbell Ave
Ste D
West Haven, CT 06516

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1621814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621814400000",
    "number": "1609441534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "266 HARRISTOWN RD STE 304",
            "city": "GLEN ROCK",
            "state": "NJ",
            "postal_code": "074523321",
            "telephone_number": "201-345-5905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4775 MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066061877",
            "telephone_number": "201-345-5905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTSMED PT OF CONNECTICUT PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-24",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-24",
        "status": "A",
        "authorized_official_last_name": "AZAR",
        "authorized_official_first_name": "CAROL",
        "authorized_official_title_or_position": "VP OF RCM",
        "authorized_official_telephone_number": "201-857-0527",
        "authorized_official_credential": "RN, BSN"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.spineandsportsmed.com",
            "affiliation": "Y",
            "endpointDescription": "Website",
            "affiliationName": "SportsMed PT LLC",
            "address_1": "266 Harristown Rd Ste 200",
            "city": "Glen Rock",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "074523354",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.spineandsportsmed.com",
            "affiliation": "Y",
            "endpointDescription": "Website",
            "affiliationName": "SportsMed PT LLC",
            "address_1": "266 Harristown Rd Ste 200",
            "city": "Glen Rock",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "074523354",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.spineandsportsmed.com",
            "affiliation": "Y",
            "endpointDescription": "Website",
            "affiliationName": "SportsMed PT LLC",
            "address_1": "266 Harristown Rd Ste 200",
            "city": "Glen Rock",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "074523354",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "SportsMed Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bridgeport, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.