Organization Active NPI

Sports & Occupation Medical Associates

  • Specialist
  • Los Gatos, CA
National Provider Identifier
1811033368
Registry record updated May 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
G60236 Issued in CA
Legal business name
SPORTS & OCCUPATION MEDICAL ASSOCIATES
Practice address
555 Knowles Dr
207
Los Gatos, CA 95032-1549
Phone
(408) 374-1110
Fax
(408) 374-1133
NPI assigned
Jan 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2010

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

Authorized official

Name
Ms. Linda Ann Dean
Title
Manager
Phone
(408) 374-1110

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X G69134 CA
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X G60236 CA Primary

Addresses

Primary practice location

555 Knowles Dr
207
Los Gatos, CA 95032-1549

Mailing address

555 Knowles Dr
207
Los Gatos, CA 95032-1549
Phone (408) 374-1110

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100804001084 CA Part B Supplier - Clinic/Group Practice 2163555681 Receives reassigned benefits from 2 practitioners
Practice locations: Los Gatos, CA

National Provider Directory

National Provider Directory

Locations

320 Dardanelli Ln
#27B
Los Gatos, CA 95032
Phone (408) 374-1110

555 Knowles Dr
Ste 207
Los Gatos, CA 95032
Phone (408) 374-1110

Practitioners & affiliated clinicians

Practitioners 2

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": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274313600000",
    "number": "1811033368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 KNOWLES DR",
            "address_2": "207",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950321549",
            "telephone_number": "408-374-1110",
            "fax_number": "408-374-1133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 KNOWLES DR",
            "address_2": "207",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950321549",
            "telephone_number": "408-374-1110",
            "fax_number": "408-374-1133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTS & OCCUPATION MEDICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2010-05-20",
        "status": "A",
        "authorized_official_last_name": "DEAN",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "408-374-1110",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G69134",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G60236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Gatos, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2010; 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.