At Direct Sports Medicine, LLC

Primary specialty

Sports Medicine (Preventive Medicine) PhysicianTaxonomy code 2083S0010X

License

1318 Issued in AZ

Legal business name

AT DIRECT SPORTS MEDICINE, LLC

Practice address

6424 E Fairfield St
Mesa, AZ 85205-6042

Phone

(520) 235-0067

NPI assigned

Sep 15, 2017

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Casey Erickson, AT

Title

Owner/Athletic Trainer

Phone

(520) 235-0067

Specialties & licenses 1

Addresses

Practitioners 1

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.

• Cassandra Erickson, MS, LAT, ATC

  • Sports Medicine (Preventive Medicine) Physician
  • Phoenix, AZ
  • NPI 1528488434
  NPD

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

{
    "created_epoch": "1505433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1720507262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6424 E FAIRFIELD ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852056042",
            "telephone_number": "520-235-0067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6424 E FAIRFIELD ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852056042",
            "telephone_number": "520-235-0067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AT DIRECT SPORTS MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-15",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "ERICKSON",
        "authorized_official_first_name": "CASEY",
        "authorized_official_title_or_position": "OWNER/ATHLETIC TRAINER",
        "authorized_official_telephone_number": "520-235-0067",
        "authorized_official_credential": "AT"
    },
    "taxonomies": [
        {
            "code": "2083S0010X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Sports Medicine",
            "state": "AZ",
            "license": "1318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sports Medicine (Preventive Medicine) Physician in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Sports Medicine (Preventive Medicine) Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.