NPIMap

Organization Active NPI

Sportsortho Anesthesia

  • Anesthesiology Physician
  • Harlingen, TX
National Provider Identifier
1639813447
Registry record updated Jul 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
SPORTSORTHO ANESTHESIA
Practice address
610 Kamali Drive
Harlingen, TX 78550-0233
Phone
(956) 465-1091
Fax
(866) 575-6395
NPI assigned
Apr 27, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2022

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

Authorized official

Name
Kim Lidbom
Title
Billing
Phone
(956) 465-1091

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

610 Kamali Drive
Harlingen, TX 78550-0233

Mailing address

610 Kamali Drive
Harlingen, TX 78550-0233
Phone (956) 465-1091

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kim@gsmithsportsortho.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220915001470 TX Part B Supplier - Clinic/Group Practice 0840675690 Receives reassigned benefits from 5 practitioners
Practice locations: Harlingen, TX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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": "1651017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658880000000",
    "number": "1639813447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 KAMALI DRIVE",
            "city": "HARLINGEN",
            "state": "TX",
            "postal_code": "785500233",
            "telephone_number": "956-465-1091",
            "fax_number": "866-575-6395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 KAMALI DRIVE",
            "city": "HARLINGEN",
            "state": "TX",
            "postal_code": "785500233",
            "telephone_number": "956-465-1091",
            "fax_number": "866-575-6395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTSORTHO ANESTHESIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-27",
        "last_updated": "2022-07-27",
        "certification_date": "2022-07-27",
        "status": "A",
        "authorized_official_last_name": "LIDBOM",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "BILLING",
        "authorized_official_telephone_number": "956-465-1091"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kim@gsmithsportsortho.com",
            "affiliation": "N",
            "endpointDescription": "Billing Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "610 Kamali Drive",
            "city": "Harlingen",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785500233",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Harlingen, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 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.