NPIMap

Organization Active NPI

Trident Sports Medicine and Rehabilitation Inc.

  • Sports Medicine (Family Medicine) Physician
  • Ormond Beach, FL
National Provider Identifier
1811766637
Registry record updated May 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
Legal business name
TRIDENT SPORTS MEDICINE AND REHABILITATION INC.
Practice address
873 Hull Rd Unit 12
Ormond Beach, FL 32174-0738
Phone
(386) 267-2965
Fax
(386) 603-6007
NPI assigned
Dec 20, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2024

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

Authorized official

Name
Michael F Lynch, DPTNPI 1194092114
Title
President
Phone
(570) 762-3953

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QS0010X Primary
Hearing and Speech Clinic/Center 261QH0700X
Physical Therapy Clinic/Center 261QP2000X

Addresses

Primary practice location

873 Hull Rd Unit 12
Ormond Beach, FL 32174-0738

Mailing address

873 Hull Rd Unit 12
Ormond Beach, FL 32174-0738
Phone (386) 267-2965

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240131001031 FL Part B Supplier - Clinic/Group Practice 4688027295 Receives reassigned benefits from 8 practitioners
Practice locations: Ormond Beach, FL

National Provider Directory

National Provider Directory

Locations

873 Hull Rd
Ormond Beach, FL 32174
Phone (386) 267-2965

873 Hull Rd
Unit 12
Ormond Beach, FL 32174
Phone (386) 258-9502

Practitioners & affiliated clinicians

Practitioners 8

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": "1703030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715126400000",
    "number": "1811766637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "873 HULL RD UNIT 12",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321740738",
            "telephone_number": "386-267-2965",
            "fax_number": "386-603-6007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "873 HULL RD UNIT 12",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321740738",
            "telephone_number": "386-267-2965",
            "fax_number": "386-603-6007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIDENT SPORTS MEDICINE AND REHABILITATION INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-20",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A",
        "authorized_official_last_name": "LYNCH",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "570-762-3953",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ormond Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; 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.