Modern Sports Medicine LLC

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

Legal business name

MODERN SPORTS MEDICINE LLC

Practice address

8240 W Cactus Rd Ste 100
Peoria, AZ 85381-5231

Phone

(480) 306-6627

Fax

(480) 306-6696

NPI assigned

Apr 5, 2023

Last updated

Sep 26, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Joshua Adams

Title

Owner

Phone

(480) 306-6627

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Other NPIs with the same Medicare PAC ID 3

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

• Modern Sports Medicine LLC

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Sun Lakes, AZ
  • NPI 1285295089

  6800228479

  Same PAC ID
• Modern Sports Medicine LLC

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Chandler, AZ
  • NPI 1912683699

  6800228479

  Same PAC ID
• Modern Sports Medicine LLC

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Mesa, AZ
  • NPI 1942810833

  6800228479

  Same PAC ID

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

{
    "created_epoch": "1680652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727308800000",
    "number": "1871298000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8240 W CACTUS RD STE 100",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853815231",
            "telephone_number": "480-306-6627",
            "fax_number": "480-306-6696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8240 W CACTUS RD STE 100",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853815231",
            "telephone_number": "480-306-6627",
            "fax_number": "480-306-6696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN SPORTS MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-05",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A",
        "authorized_official_last_name": "ADAMS",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-306-6627"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ronald Joseph Mittel Jr., M.D.
• McKenzie Helene Mitton
• Caroline Waceke Miya, NP
• Radostin Iliev Mladenov, RDH
• MMC Doc MD LLC
• Sonya M. Mody, M.D.
• Mohamed Khirfan PLLC
• Mohammad Jamil PC (Icare Internal Medicine)
• Paige McKenna Mohl, OD
• Kevin Moler, LPC

• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 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.