NPIMap

Organization Active NPI

Orthopedic Center for Sports Medicine

  • Orthopaedic Surgery Physician
  • Davenport, FL
National Provider Identifier
1831521756
Registry record updated Jan 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
ME72924 Issued in FL
Legal business name
ORTHOPEDIC CENTER FOR SPORTS MEDICINE
Practice address
105 Park Place Blvd
Suite a
Davenport, FL 33837-6858
Phone
(863) 421-7411
Fax
(863) 547-9514
NPI assigned
Aug 1, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2016

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

Authorized official

Name
Mr. Robert Mathis
Title
Administrator
Phone
(863) 421-7411

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X ME72924 FL Primary

Addresses

Primary practice location

105 Park Place Blvd
Suite a
Davenport, FL 33837-6858

Mailing address

105 Park Place Blvd
Suite a
Davenport, FL 33837-6858
Phone (863) 421-7411

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1375315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453161600000",
    "number": "1831521756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 PARK PLACE BLVD",
            "address_2": "SUITE A",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "338376858",
            "telephone_number": "863-421-7411",
            "fax_number": "863-547-9514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 PARK PLACE BLVD",
            "address_2": "SUITE A",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "338376858",
            "telephone_number": "863-421-7411",
            "fax_number": "863-547-9514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPEDIC CENTER FOR SPORTS MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-01",
        "last_updated": "2016-01-19",
        "status": "A",
        "authorized_official_last_name": "MATHIS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "863-421-7411",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "FL",
            "license": "ME72924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2016; 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.