NPIMap

Organization Active NPI

Sport Medicine and Orthopaedic Center Inc

Doing business as Sports Medicine Othopaedics Center

  • Orthopaedic Surgery Physician
  • Suffolk, VA
National Provider Identifier
1699243402
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
SPORT MEDICINE AND ORTHOPAEDIC CENTER INC
Doing business as
Sports Medicine Othopaedics Center
Practice address
5801 Harbour View Blvd
Suffolk, VA 23435-2657
Phone
(757) 547-5145
NPI assigned
Nov 9, 2018
Last updated
Aug 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

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

Authorized official

Name
Debra Runge-Ashby
Title
Director of Revenue Cycle
Phone
(757) 547-5145

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X Primary

Addresses

Primary practice location

5801 Harbour View Blvd
Suffolk, VA 23435-2657

Mailing address

501 Discovery Dr
Chesapeake, VA 23320-3832
Phone (757) 547-5145

Other names 1

  • Sports Medicine Othopaedics Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190124000847 VA DME Supplier - Physician - Orthopedic/Orthopedic Surgery 8921046616 Practice locations: Suffolk, VA

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Star Clinic GRP4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Practitioners & affiliated clinicians

Practitioners 4

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": "1541721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1699243402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 DISCOVERY DR",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233203832",
            "telephone_number": "757-547-5145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5801 HARBOUR VIEW BLVD",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234352657",
            "telephone_number": "757-547-5145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORT MEDICINE AND ORTHOPAEDIC CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-09",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A",
        "authorized_official_last_name": "RUNGE-ASHBY",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE CYCLE",
        "authorized_official_telephone_number": "757-547-5145"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sports Medicine Othopaedics Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sports Medicine Othopaedics Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Suffolk, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2024; 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.