Organization Active NPI

Ultimate Sports & Orthopaedics

  • Orthopaedic Surgery Physician
  • Apple Valley, CA
National Provider Identifier
1790796480
Registry record updated Feb 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
ULTIMATE SPORTS & ORTHOPAEDICS
Practice address
15990 Tuscola Rd
Apple Valley, CA 92307-2111
Phone
(760) 242-4808
Fax
(760) 242-4889
NPI assigned
Aug 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2013

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

Authorized official

Name
Mr. Samuel Henry Rice, MDNPI 1780667899
Title
President
Phone
(760) 242-4808

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
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X Primary

Addresses

Primary practice location

15990 Tuscola Rd
Apple Valley, CA 92307-2111

Mailing address

15990 Tuscola Rd
Apple Valley, CA 92307-2111
Phone (760) 242-4808

Other names 1

  • Summit Orthopaedic Associates Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041119000577 CA Part B Supplier - Clinic/Group Practice 0648235549 Receives reassigned benefits from 3 practitioners
Practice locations: Apple Valley, CA

National Provider Directory

National Provider Directory

Locations

15990 Tuscola Rd
Apple Valley, CA 92307
Phone (760) 242-4808

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361923200000",
    "number": "1790796480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15990 TUSCOLA RD",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923072111",
            "telephone_number": "760-242-4808",
            "fax_number": "760-242-4889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15990 TUSCOLA RD",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923072111",
            "telephone_number": "760-242-4808",
            "fax_number": "760-242-4889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ULTIMATE SPORTS & ORTHOPAEDICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2013-02-27",
        "status": "A",
        "authorized_official_last_name": "RICE",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "HENRY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "760-242-4808",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Summit Orthopaedic Associates",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Apple Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2013; 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.