NPIMap

Organization Active NPI

Orthopedic & Sports Physical Therapy Center LLC

  • Physical Therapy Clinic/Center
  • Niceville, FL
National Provider Identifier
1881632008
Registry record updated Apr 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
ORTHOPEDIC & SPORTS PHYSICAL THERAPY CENTER LLC
Practice address
1950 Bluewater Blvd
Suite 101
Niceville, FL 32578-3888
Phone
(850) 897-3334
Fax
(850) 897-7855
NPI assigned
Jun 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2016

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

Authorized official

Name
Ms. Nicole Sheppard
Title
Practice Administrator
Phone
(850) 897-3334

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

1950 Bluewater Blvd
Suite 101
Niceville, FL 32578-3888

Mailing address

1950 Bluewater Blvd
Suite 101
Niceville, FL 32578-3888
Phone (850) 897-3334

Other identifiers 2

IdentifierTypeStateIssuer
Y906WOtherFLBCBSFL CLINIC #
8913153-00MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050418000712 FL Part B Supplier - Clinic/Group Practice 0941248397 Receives reassigned benefits from 10 practitioners
1 other NPI on this enrollment
Practice locations: Niceville, FL; Santa Rosa Beach, FL; Destin, FL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Orthopedic and Sports Physical Therapy C4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Practitioners & affiliated clinicians

Practitioners 11

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": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461801600000",
    "number": "1881632008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 BLUEWATER BLVD",
            "address_2": "SUITE 101",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325783888",
            "telephone_number": "850-897-3334",
            "fax_number": "850-897-7855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 BLUEWATER BLVD",
            "address_2": "SUITE 101",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325783888",
            "telephone_number": "850-897-3334",
            "fax_number": "850-897-7855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPEDIC & SPORTS PHYSICAL THERAPY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "last_updated": "2016-04-28",
        "status": "A",
        "authorized_official_last_name": "SHEPPARD",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "850-897-3334",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSFL CLINIC #",
            "identifier": "Y906W",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8913153-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Niceville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2016; 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.