NPIMap

Organization Active NPI

Axis Sports Medicine, LLC

Doing business as Axis Sports Medicine

  • Physical Therapist
  • Eagle, CO
National Provider Identifier
1699432807
Registry record updated Nov 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
AXIS SPORTS MEDICINE, LLC
Doing business as
Axis Sports Medicine
Practice address
1143 Capitol St Unit 102B
Eagle, CO 81631-5000
Phone
(970) 328-4566
Fax
(970) 328-5591
NPI assigned
Nov 22, 2021
Last updated
Nov 22, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2021

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

Authorized official

Name
Amy Freeman
Title
Practice Manager
Phone
(970) 406-2559

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

1143 Capitol St Unit 102B
Eagle, CO 81631-5000

Mailing address

PO Box 5584
Frisco, CO 80443-5584

Other identifiers 1

IdentifierTypeStateIssuer
9000148002MedicaidCO

Other names 1

  • Axis Sports Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121107000390 CO Part B Supplier - Physical/Occupational Therapy Group in Private Practice 7214188895 Receives reassigned benefits from 24 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Avon, CO; Silverthorne, CO; Frisco, CO; Breckenridge, CO; Eagle, CO

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Axis Sports Medicine5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Practitioners & affiliated clinicians

Practitioners 5

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": "1637539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637539200000",
    "number": "1699432807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5584",
            "city": "FRISCO",
            "state": "CO",
            "postal_code": "804435584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1143 CAPITOL ST UNIT 102B",
            "city": "EAGLE",
            "state": "CO",
            "postal_code": "816315000",
            "telephone_number": "970-328-4566",
            "fax_number": "970-328-5591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AXIS SPORTS MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-22",
        "last_updated": "2021-11-22",
        "certification_date": "2021-11-22",
        "status": "A",
        "authorized_official_last_name": "FREEMAN",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "970-406-2559"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000148002",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Axis Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eagle, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2021; 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.