Organization Active NPI

Orthopedic and Sports Medicine

  • Orthopaedic Surgery Physician
  • Sherman, TX
National Provider Identifier
1629018395
Registry record updated May 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
ORTHOPEDIC AND SPORTS MEDICINE
Practice address
321 N Highland Ave Ste 120
Sherman, TX 75092-7371
Phone
(903) 870-7936
Fax
(903) 957-0367
NPI assigned
Jun 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 25, 2022

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

Authorized official

Name
Dr. Stephen Degnan Sandoval, M.D.NPI 1205986882
Title
Partner
Phone
(903) 870-7936

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X TX Primary

Addresses

Primary practice location

321 N Highland Ave Ste 120
Sherman, TX 75092-7371

Mailing address

321 N Highland Ave Ste 120
Sherman, TX 75092
Phone (903) 870-7936

Other identifiers 3

IdentifierTypeStateIssuer
079825801MedicaidTX
100755120AMedicaidOK
0095CGOtherTXBLUE CROSS BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040923000486 TX Part B Supplier - Clinic/Group Practice 9638147671 Receives reassigned benefits from 1 practitioner
Practice locations: Sherman, TX

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Locations

321 N Highland Ave
Ste 120
Sherman, TX 75092
Phone (903) 870-7936

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653436800000",
    "number": "1629018395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 N HIGHLAND AVE STE 120",
            "city": "SHERMAN",
            "state": "TX",
            "postal_code": "75092",
            "telephone_number": "903-870-7936",
            "fax_number": "903-957-0367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 N HIGHLAND AVE STE 120",
            "city": "SHERMAN",
            "state": "TX",
            "postal_code": "750927371",
            "telephone_number": "903-870-7936",
            "fax_number": "903-957-0367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPEDIC AND SPORTS MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-08",
        "last_updated": "2022-05-25",
        "certification_date": "2022-05-25",
        "status": "A",
        "authorized_official_last_name": "SANDOVAL",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "DEGNAN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "903-870-7936",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "079825801",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100755120A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0095CG",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sherman, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2022; 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.