NPIMap

Organization Active NPI

Temple University of the Commonwealth System of Higher Education

Doing business as NJ Sports Medicine Temple

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Marlton, NJ
National Provider Identifier
1932197563
Registry record updated Feb 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
Legal business name
TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION
Doing business as
NJ Sports Medicine Temple
Practice address
Route 73 N
One Greentree Center
Marlton, NJ 08053
Phone
(856) 596-0906
Fax
(856) 596-6918
NPI assigned
Oct 7, 2005
Last updated
Feb 13, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2017

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

Authorized official

Name
Ms. Tracey J Clark
Title
Director, Government and Payer Rela
Phone
(856) 596-0906

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XX0005X Primary

Addresses

Primary practice location

Route 73 N
One Greentree Center
Marlton, NJ 08053

Mailing address

2450 W Hunting Park Ave
Philadelphia, PA 19129-1302
Phone (856) 596-0609

Other identifiers 1

IdentifierTypeStateIssuer
6202403MedicaidNJ

Other names 1

  • NJ Sports Medicine Temple Doing business as

National Provider Directory

National Provider Directory

Locations

220 Commerce Dr
Ste 100
Ft Washington, PA 19034
Phone (215) 641-0700

1200 Constitution Ave
Philadelphia, PA 19112
Phone (215) 755-2340

1077 Rydal Rd
Ste 201
Rydal, PA 19046
Phone (215) 885-4849

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1128643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486944000000",
    "number": "1932197563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 W HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291302",
            "telephone_number": "856-596-0609",
            "fax_number": "856-596-6918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ROUTE 73 N",
            "address_2": "ONE GREENTREE CENTER",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "08053",
            "telephone_number": "856-596-0906",
            "fax_number": "856-596-6918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-07",
        "last_updated": "2017-02-13",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR, GOVERNMENT AND PAYER RELA",
        "authorized_official_telephone_number": "856-596-0906",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6202403",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NJ Sports Medicine Temple",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marlton, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2017; 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.