Springfield Spine & Sport, Inc.

Primary specialty

Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X

License

35067942 Issued in OH

Legal business name

SPRINGFIELD SPINE & SPORT, INC.

Practice address

4960 Middle Urbana Rd
Springfield, OH 45503-6040

Phone

(937) 399-8366

Fax

(937) 399-8379

NPI assigned

Nov 13, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Pamela K Gothard

Title

Office Manager

Phone

(937) 399-8366

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• MARTIN F. BERTRAM, MD Other name

Locations

Practitioners 1

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

• Ryan S Reeves, MD

  • Physical Medicine & Rehabilitation Physician
  • Southlake, TX
  • NPI 1669406724
  NPD (past)

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

{
    "created_epoch": "1194912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1801076369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4960 MIDDLE URBANA RD",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455036040",
            "telephone_number": "937-399-8366",
            "fax_number": "937-399-8379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4960 MIDDLE URBANA RD",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455036040",
            "telephone_number": "937-399-8366",
            "fax_number": "937-399-8379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRINGFIELD SPINE & SPORT, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-13",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "GOTHARD",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "937-399-8366",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "OH",
            "license": "35067942",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0110963",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO BUREAU WORKERS COMP",
            "identifier": "389824050015",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000038962",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MARTIN F. BERTRAM, MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Springfield Regional Cancer Center, LLC
• Springfield Regional Outpatient Surgery Center LLC
• Springfield SNF Opco LLC
• Springfield SNF Opco LLC
• Springfield SNF, Inc.
• Springfield Sports Academy
• Springfield Surgery Center LP
• Springfield Township Trustees
• Springfield Urology LLC
• Steven Mark Stackhouse, D.D.S.

• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Springfield, OH
• Providers in Springfield, OH by specialty
• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.