NPIMap

Organization Active NPI

The Pennsylvania State University

Doing business as Pennsylvania State University Sports Medicine

  • Orthopaedic Surgery Physician
  • University Park, PA
National Provider Identifier
1861949869
Registry record updated Feb 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
MD062970L Issued in PA
Legal business name
THE PENNSYLVANIA STATE UNIVERSITY
Doing business as
Pennsylvania State University Sports Medicine
Practice address
408 Old Main
University Park, PA 16802-1505
Phone
(814) 865-4700
NPI assigned
Sep 7, 2016
Last updated
Feb 27, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2024

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

Authorized official

Name
Mouzon Bass III
Title
Agent
Phone
(972) 367-4845

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207X00000X MD062970L PA Primary

Addresses

Primary practice location

408 Old Main
University Park, PA 16802-1505

Mailing address

5050 Spring Valley Rd.
Dallas, TX 75244-3909

Other names 1

  • Pennsylvania State University Sports Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pennsylvania State University11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

NPI Registry JSON

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

{
    "created_epoch": "1473206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708992000000",
    "number": "1861949869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5050 SPRING VALLEY RD.",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752443909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 OLD MAIN",
            "city": "UNIVERSITY PARK",
            "state": "PA",
            "postal_code": "168021505",
            "telephone_number": "814-865-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PENNSYLVANIA STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-07",
        "last_updated": "2024-02-27",
        "certification_date": "2024-02-27",
        "status": "A",
        "authorized_official_last_name": "BASS",
        "authorized_official_first_name": "MOUZON",
        "authorized_official_title_or_position": "AGENT",
        "authorized_official_telephone_number": "972-367-4845",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "PA",
            "license": "MD062970L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pennsylvania State University Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in University Park, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2024; 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.