Spartan Orthopaedics, LLC

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

Legal business name

SPARTAN ORTHOPAEDICS, LLC

Doing business as

Champion Orthopaedics, LLC

Practice address

6518 Goodman Rd Ste 104
Olive Branch, MS 38654-9809

Phone

(662) 420-7350

Fax

(662) 932-3010

NPI assigned

Sep 15, 2015

Last updated

Jul 28, 2026By the provider in NPPES

Organization subpart

Yes

Parent organization

SPARTAN ORTHOPAEDICS, LLCAs reported in NPPES

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

Authorized official

Name

Jennifer C Bullock

Title

President

Phone

(662) 534-2298

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• Champion Orthopaedics, LLC Doing business as

Electronic endpoints 3

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Spartan Orthopaedics, LLC

  • Orthopaedic Surgery Physician
  • New Albany, MS
  • NPI 1972791978

  4880778786

  Same PAC ID

Part of

Orthoone Orthpaedics Sport

Interoperability endpoints

• Direct secure messaging: hanna.mitias.1@11099.direct.athenahealth.com
• Direct secure messaging: johnathan.thompson.1@11099.direct.athenahealth.com
• Direct secure messaging: kevin.yekaitis.1@11099.direct.athenahealth.com

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Spartan Orthopaedics, LLC

  • Orthopaedic Surgery Physician
  • New Albany, MS
  • NPI 1972791978
  NPPES parent name

Practitioners 3

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.

• Colton Dunn, FNP-C

  • Family Nurse Practitioner
  • Olive Branch, MS
  • NPI 1568841088
  NPD
• Matthew Reese Pannell, FNP-C

  • Nurse Practitioner
  • New Albany, MS
  • NPI 1407506603

  Single Specialty

  NPD
• Cameron Mitchell Wilkerson, FNP-C

  • Nurse Practitioner
  • New Albany, MS
  • NPI 1386378396
  NPD

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

{
    "created_epoch": "1442275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785196800000",
    "number": "1619346111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6518 GOODMAN RD STE 104",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386549809",
            "telephone_number": "662-420-7350",
            "fax_number": "662-932-3010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6518 GOODMAN RD STE 104",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386549809",
            "telephone_number": "662-420-7350",
            "fax_number": "662-932-3010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARTAN ORTHOPAEDICS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPARTAN ORTHOPAEDICS, LLC",
        "enumeration_date": "2015-09-15",
        "last_updated": "2026-07-28",
        "certification_date": "2026-07-28",
        "status": "A",
        "authorized_official_last_name": "BULLOCK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-534-2298"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DME PTAN",
            "identifier": "6131110004",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200025185",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "512G700048",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kevin.yekaitis.1@11099.direct.athenahealth.com",
            "affiliation": "Y",
            "endpointDescription": "Kevin Yekaitis's Direct Email",
            "affiliationName": "Mitias Orthopaedics, PLLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "6518 Goodman Rd Ste 104",
            "city": "Olive Branch",
            "state": "MS",
            "country_code": "US",
            "postal_code": "386549809",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hanna.mitias.1@11099.direct.athenahealth.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "6518 Goodman Rd Ste 104",
            "city": "Olive Branch",
            "state": "MS",
            "country_code": "US",
            "postal_code": "386549809",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "johnathan.thompson.1@11099.direct.athenahealth.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "6518 Goodman Rd Ste 104",
            "city": "Olive Branch",
            "state": "MS",
            "country_code": "US",
            "postal_code": "386549809",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Champion Orthopaedics, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary Elizabeth Smith, P-LPC, LAC
• Robin Powe Smith, PT,DPT
• Southern Pain and Regenerative Medicine PC
• Southern Vascular and Pain Surgery Center Olive Branch LLC
• Southland Wellness PLLC
• Marecia Mreana Spearman
• Patrick L Spears
• Specialty Care Extended Hours Clinic LLC (Specialty Care Extended Hours Clinic)
• Specialty Hospice,LLC (ACG Hospice)
• Kristin Cox Spence, APN, FNP

• Orthopaedic Surgery Physician in Olive Branch, MS
• Providers in Olive Branch, MS by specialty
• Orthopaedic Surgery Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2026; 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.