NPIMap

Organization Active NPI

Orem Sports Medicine Center, LLC

  • Physical Therapist
  • Orem, UT
National Provider Identifier
1659397313
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
4739582-2401 Issued in UT
Legal business name
OREM SPORTS MEDICINE CENTER, LLC
Practice address
980 E 800 N Ste 103
Orem, UT 84097-4261
Phone
(801) 226-0599
Fax
(801) 226-3145
NPI assigned
Jul 14, 2006
Last updated
Nov 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Authorized official

Name
Mr. Matthew F Bushnell, DPTNPI 1033402607
Title
Owner
Phone
(801) 830-3034

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 Therapist 225100000X 4739582-2401 UT Primary

Addresses

Primary practice location

980 E 800 N Ste 103
Orem, UT 84097-4261

Mailing address

524 W 300 N Ste 201
Provo, UT 84601-2669
Phone (801) 370-9981

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031202000160 UT Part B Supplier - Clinic/Group Practice 0941105191 Receives reassigned benefits from 7 practitioners
Practice locations: Orem, UT; Provo, UT

National Provider Directory

National Provider Directory

Locations

252 N State St
Orem, UT 84057
Phone (801) 226-0599

459 W Center St
Orem, UT 84057
Phone (801) 226-0599

980 E 800 N
Ste 103
Orem, UT 84097
Phone (801) 226-0599

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1659397313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "524 W 300 N STE 201",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846012669",
            "telephone_number": "801-370-9981",
            "fax_number": "801-370-9984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "980 E 800 N STE 103",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840974261",
            "telephone_number": "801-226-0599",
            "fax_number": "801-226-3145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OREM SPORTS MEDICINE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A",
        "authorized_official_last_name": "BUSHNELL",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-830-3034",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "4739582-2401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orem, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.