NPIMap

Organization Active NPI

Sports Medicine and Orthopaedic Institute

Doing business as Premier Orthopaedic Trauma Specialists, PMC

  • Adult Reconstructive Orthopaedic Surgery Physician
  • Victorville, CA
National Provider Identifier
1669993218
Registry record updated Feb 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Reconstructive Orthopaedic Surgery PhysicianTaxonomy code 207XS0114X
License
A144350 Issued in CA
Legal business name
SPORTS MEDICINE AND ORTHOPAEDIC INSTITUTE
Doing business as
Premier Orthopaedic Trauma Specialists, PMC
Practice address
12490 Business Center Dr Ste 100
Victorville, CA 92395-5833
Phone
(760) 522-8585
Fax
(760) 243-4276
NPI assigned
Jul 5, 2017
Last updated
Feb 13, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
SPORTS MEDICINE AND ORTHOPAEDIC INSTITUTE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 13, 2025

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

Authorized official

Name
Dr. Samir Nayyar, M.D.NPI 1063703270
Title
President
Phone
(760) 552-8585

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X A144350 CA
Adult Reconstructive Orthopaedic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207XS0114X A144350 CA Primary

Addresses

Primary practice location

12490 Business Center Dr Ste 100
Victorville, CA 92395-5833

Mailing address

17100B Bear Valley Rd # 283
Victorville, CA 92395-5851
Phone (760) 552-8585

Other practice location 1

400 N Mountain Ave Ste 100
Upland, CA 91786-5194
Phone (909) 596-4346

Other practice location 2

160 E Artesia St Ste 255
Pomona, CA 91767-2921
Phone (909) 596-4346

Other practice location 3

2150 N Waterman Ave Ste 303
San Bernardino, CA 92404-4811
Phone (760) 552-8585

Other practice location 4

2140 Grand Ave Ste 120
Chino Hills, CA 91709-6801
Phone (909) 596-4346

Other practice location 5

1770 N Orange Grove Ave Ste 210
Pomona, CA 91767-3027
Phone (760) 552-8585

Other practice location 6

400 N Mountain Ave Ste 310
Upland, CA 91786-5182
Phone (909) 596-4346

Other practice location 7

1325 N Rose Dr Ste 210
Placentia, CA 92870-3800
Phone (909) 596-4346

Other practice location 8

1890 W Main St Ste 130
Barstow, CA 92311-3726
Phone (760) 552-8585

Other practice location 9

25915 Barton Rd Ste 203
Loma Linda, CA 92354-3818
Phone (760) 552-8585

Other practice location 10

264 N Highland Ave
Bld 3 Suite B
Banning, CA 92220
Phone (760) 552-8585

Other names 1

  • PREMIER ORTHOPAEDIC TRAUMA SPECIALISTS, PMC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20161101002657 CA Part B Supplier - Clinic/Group Practice 4082992623 Receives reassigned benefits from 49 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Upland, CA; Victorville, CA; San Dimas, CA; San Bernardino, CA; Pomona, CA; Banning, CA; Loma Linda, CA; Riverside, CA…
O20171017000976 CA Part B Supplier - Clinic/Group Practice 7911273180 Receives reassigned benefits from 21 practitioners
Practice locations: Banning, CA; Pomona, CA; Rancho Cucamonga, CA; San Bernardino, CA; Victorville, CA

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Premier Orthopaedic Trauma2 organizations share this tax ID, including this one
Part of
Sports Medicine and Orthopaedic Institute

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

264 N Highland Springs Ave
Ste B
Banning, CA 92220

1250 N Waterman Ave Ste 302303
San Bernardino, CA 92404

400 N Mountain Ave
Ste 100
Upland, CA 91786

12490 Business Center Dr
#100
Victorville, CA 92395
Phone (605) 528-5857

13010 Hesperia Rd
Ste 300
Victorville, CA 92395
Phone (760) 843-7873

17100 Bear Valley Rd
Ste B
Victorville, CA 92395
Phone (760) 912-9899

Practitioners & affiliated clinicians

Practitioners 54

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.

View all 54

NPI Registry JSON

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

{
    "created_epoch": "1499212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739404800000",
    "number": "1669993218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17100B BEAR VALLEY RD # 283",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955851",
            "telephone_number": "760-552-8585",
            "fax_number": "760-243-4276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12490 BUSINESS CENTER DR STE 100",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955833",
            "telephone_number": "760-522-8585",
            "fax_number": "760-243-4276"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 N Mountain Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Upland",
            "state": "CA",
            "postal_code": "917865194",
            "country_code": "US",
            "telephone_number": "909-596-4346",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "160 E Artesia St Ste 255",
            "address_purpose": "LOCATION",
            "city": "Pomona",
            "state": "CA",
            "postal_code": "917672921",
            "country_code": "US",
            "telephone_number": "909-596-4346",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2150 N Waterman Ave Ste 303",
            "address_purpose": "LOCATION",
            "city": "San Bernardino",
            "state": "CA",
            "postal_code": "924044811",
            "country_code": "US",
            "telephone_number": "760-552-8585",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2140 Grand Ave Ste 120",
            "address_purpose": "LOCATION",
            "city": "Chino Hills",
            "state": "CA",
            "postal_code": "917096801",
            "country_code": "US",
            "telephone_number": "909-596-4346",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1770 N Orange Grove Ave Ste 210",
            "address_purpose": "LOCATION",
            "city": "Pomona",
            "state": "CA",
            "postal_code": "917673027",
            "country_code": "US",
            "telephone_number": "760-552-8585",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 N Mountain Ave Ste 310",
            "address_purpose": "LOCATION",
            "city": "Upland",
            "state": "CA",
            "postal_code": "917865182",
            "country_code": "US",
            "telephone_number": "909-596-4346",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1325 N Rose Dr Ste 210",
            "address_purpose": "LOCATION",
            "city": "Placentia",
            "state": "CA",
            "postal_code": "928703800",
            "country_code": "US",
            "telephone_number": "909-596-4346",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1890 W Main St Ste 130",
            "address_purpose": "LOCATION",
            "city": "Barstow",
            "state": "CA",
            "postal_code": "923113726",
            "country_code": "US",
            "telephone_number": "760-552-8585",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "25915 Barton Rd Ste 203",
            "address_purpose": "LOCATION",
            "city": "Loma Linda",
            "state": "CA",
            "postal_code": "923543818",
            "country_code": "US",
            "telephone_number": "760-552-8585",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "264 N Highland Ave",
            "address_2": "Bld 3 Suite B",
            "address_purpose": "LOCATION",
            "city": "Banning",
            "state": "CA",
            "postal_code": "92220",
            "country_code": "US",
            "telephone_number": "760-552-8585",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SPORTS MEDICINE AND ORTHOPAEDIC INSTITUTE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPORTS MEDICINE AND ORTHOPAEDIC INSTITUTE, INC.",
        "enumeration_date": "2017-07-05",
        "last_updated": "2025-02-13",
        "certification_date": "2025-02-10",
        "status": "A",
        "authorized_official_last_name": "NAYYAR",
        "authorized_official_first_name": "SAMIR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "760-552-8585",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "A144350",
            "primary": false
        },
        {
            "code": "207XS0114X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "CA",
            "license": "A144350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PREMIER ORTHOPAEDIC TRAUMA SPECIALISTS, PMC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PREMIER ORTHOPAEDIC TRAUMA SPECIALISTS, PMC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Victorville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2025; 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.