Sports Medicine Surgical Specialists PLLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

SPORTS MEDICINE SURGICAL SPECIALISTS PLLC

Doing business as

Kentuckiana Foot and Ankle Sports Medicine

Practice address

210 E Gray St # 820
Louisville, KY 40202-3900

Phone

(502) 585-3668

Fax

(502) 585-3662

NPI assigned

Apr 16, 2019

Organization subpart

No

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

Authorized official

Name

Keith Wellington Myrick, DPM

Title

Owner/Authorized Official

Phone

(502) 721-8288

Specialties & licenses 2

Addresses

Other names 1

• Kentuckiana Foot and Ankle Sports Medicine Doing business as

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Sports Medicine Surgical Specialists PLLC

  • Foot & Ankle Surgery Podiatrist
  • Louisville, KY
  • NPI 1689070559

  5597089367

  Same PAC ID
• Sports Medicine Surgical Specialists PLLC

  • Durable Medical Equipment & Medical Supplies
  • Louisville, KY
  • NPI 1861357899

  5597089367

  Same PAC ID

Tax ID family

Sports Medicine Surg PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Sports Medicine Surgical Specialists PLLC

  • Durable Medical Equipment & Medical Supplies
  • Louisville, KY
  • NPI 1861357899
  NPD tax ID

Locations

Practitioners 1

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

• Tyler Tewilliager, DPM

  • Podiatrist
  • Houma, LA
  • NPI 1295230118
  NPD

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

{
    "created_epoch": "1555372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622592000000",
    "number": "1821651852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6400 DUTCHMANS PKWY STE 215",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402053343",
            "telephone_number": "502-721-8288",
            "fax_number": "502-721-8792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 E GRAY ST # 820",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402023900",
            "telephone_number": "502-585-3668",
            "fax_number": "502-585-3662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTS MEDICINE SURGICAL SPECIALISTS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-16",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A",
        "authorized_official_last_name": "MYRICK",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "WELLINGTON",
        "authorized_official_title_or_position": "OWNER/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "502-721-8288",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kentuckiana Foot and Ankle Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Betty Sue Spivack, M.D.
• Megan J Spivak, LCSW
• Lindsey Dawn Spivey, APRN
• Towanda Meketa Splunge
• Sports Medicine Surgical Specialists PLLC
• Sports Medicine Surgical Specialists PLLC
• Sportsrx LLC
• Kaelyn Noelle Spowart
• Amela Spradling, CRNA
• Corey Spragens

• Durable Medical Equipment & Medical Supplies in Louisville, KY
• Providers in Louisville, KY by specialty
• Durable Medical Equipment & Medical Supplies in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2021; 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.