Spine & Sports Surgical Center, LLC.

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SPINE & SPORTS SURGICAL CENTER, LLC.

Practice address

1120 W la Veta Ave
300
Orange, CA 92868-4231

Phone

(714) 598-1745

Fax

(714) 941-9539

NPI assigned

Jan 16, 2015

Last updated

Apr 20, 2021By 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

Gregory D Carlson, MDNPI 1215924329

Title

President

Phone

(714) 598-1745

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Spine and Sports Surgical Center LLCCCN 05C0002100

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

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.

• Gregory D. Carlson, M.D.

  • Orthopaedic Surgery of the Spine Physician
  • Orange, CA
  • NPI 1215924329
  Authorized official Same address or phone
• Sameh Adel Assad, MD

  • Anesthesiology Physician
  • Pueblo, CO
  • NPI 1699745406
  NPD (past)

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

{
    "created_epoch": "1421366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618876800000",
    "number": "1932598760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 W LA VETA AVE # 330",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928684231",
            "telephone_number": "714-598-1745",
            "fax_number": "714-941-9539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 W LA VETA AVE",
            "address_2": "300",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928684231",
            "telephone_number": "714-598-1745",
            "fax_number": "714-941-9539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE & SPORTS SURGICAL CENTER, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-16",
        "last_updated": "2021-04-20",
        "certification_date": "2021-04-20",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-598-1745",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Daniella Spidle
• Stella Alexandra Spiegel
• Lindsey Spiegelman, MD
• Savanna Marie Spielman
• Katie Spiers
• Spine and Sports Imaging LLC
• Spine and Sports Specialities Medical Group
• Spine and Sports Urgent Care Center Inc.
• Eugene Michael Spiritus, MD
• Abraham Spitzer-Tilchin

• Ambulatory Surgical Clinic/Center in Orange, CA
• Providers in Orange, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.