Premier Spine and Sports Medicine, P.C.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

25MA08795900 Issued in NJ

Legal business name

PREMIER SPINE AND SPORTS MEDICINE, P.C.

Practice address

1555 Center Ave
Fort Lee, NJ 07024-4612

Phone

(201) 242-1600

NPI assigned

Feb 13, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Ruby E Kim, M.D.NPI 1972762730

Title

Physician

Phone

(201) 242-1600

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 4

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

• Ruby Kim, M.D.

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Fort Lee, NJ
  • NPI 1972762730
  Medicare reassignment Care Compare group Authorized official
• Sophia Yae, DO

  • Physical Medicine & Rehabilitation Physician
  • Wayne, NJ
  • NPI 1154984334
  Medicare reassignment Care Compare group
• Sarah Shin Young Kim, NP

  • Family Nurse Practitioner
  • Fort Lee, NJ
  • NPI 1275275125
  NPD (past)
• Jensy Clara Kalavelil

  • Physician Assistant
  • New York, NY
  • NPI 1639700982
  NPD (past)

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

{
    "created_epoch": "1360713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380240000000",
    "number": "1811236672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 CENTER AVE",
            "address_2": "2ND FLOOR",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070244612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 CENTER AVE",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070244612",
            "telephone_number": "201-242-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER SPINE AND SPORTS MEDICINE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-13",
        "last_updated": "2013-09-27",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "RUBY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "201-242-1600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NJ",
            "license": "25MA08795900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "150155GF6",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacob Pourat, DDS MS
• Phalimar S Prabhu, MD
• Premier Home Health Care Services
• Premier Home Health Care Services, Inc.
• Premier Professional Temps
• Professional Care Home Care Agency, Inc.
• Professional Occupational & Physical Therapy, PLLC
• Professional Occupational & Physical Therapy, PLLC
• Professional Oral Surgery Alliance of New Jersey, LLC
• Professional Orthopedic and Sports Therapy of NJ, LLC

• Physical Medicine & Rehabilitation Physician in Fort Lee, NJ
• Providers in Fort Lee, NJ by specialty
• Physical Medicine & Rehabilitation Physician in New Jersey

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