NPIMap

Organization Active NPI

Premier Sports Medicine and Physical Therapy

  • Physical Therapy Clinic/Center
  • Santa Cruz, CA
National Provider Identifier
1629238191
Registry record updated Feb 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
25727 Issued in CA
Legal business name
PREMIER SPORTS MEDICINE AND PHYSICAL THERAPY
Practice address
1003 River St
Suite C
Santa Cruz, CA 95060-1754
Phone
(831) 457-1800
Fax
(831) 457-1802
NPI assigned
Jun 9, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2009

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

Authorized official

Name
Eric IngramNPI 1649209065
Title
Owner
Phone
(831) 457-1800

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
Physical Therapy Clinic/Center 261QP2000X 25727 CA Primary

Addresses

Primary practice location

1003 River St
Suite C
Santa Cruz, CA 95060-1754

Mailing address

PO Box 3751
Santa Cruz, CA 95063-3751
Phone (831) 457-1800

Other identifiers 1

IdentifierTypeStateIssuer
AO096ZOtherCAPTAN

Other names 1

  • Premier Physical Therapy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081008000585 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 7517035249 Receives reassigned benefits from 4 practitioners
Practice locations: Santa Cruz, CA

National Provider Directory

National Provider Directory

Locations

1003 River St
Ste C
Santa Cruz, CA 95060
Phone (831) 345-9437

Practitioners & affiliated clinicians

Practitioners 9

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": "1212969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234137600000",
    "number": "1629238191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3751",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950633751",
            "telephone_number": "831-457-1800",
            "fax_number": "831-457-1802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 RIVER ST",
            "address_2": "SUITE C",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950601754",
            "telephone_number": "831-457-1800",
            "fax_number": "831-457-1802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER SPORTS MEDICINE AND PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-09",
        "last_updated": "2009-02-09",
        "status": "A",
        "authorized_official_last_name": "INGRAM",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "831-457-1800"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CA",
            "license": "25727",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "AO096Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Cruz, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2009; 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.