Santa Rosa Sports Medicine, Incorporated

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

G073843 Issued in CA

Legal business name

SANTA ROSA SPORTS MEDICINE, INCORPORATED

Practice address

1255 N Dutton Ave
Santa Rosa, CA 95401-4663

Phone

(707) 546-9400

Fax

(707) 546-9464

NPI assigned

Nov 6, 2008

Last updated

Oct 13, 2014By 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

Dr. Ty Preston Affleck, M.D.NPI 1306941083

Title

President

Phone

(707) 546-9400

Specialties & licenses 1

Addresses

Other names 1

• Santa Rosa Sports and Family Medicine Other name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

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.

• Ty Preston Affleck, MD

  • Sports Medicine (Family Medicine) Physician
  • Santa Rosa, CA
  • NPI 1306941083
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1225929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413158400000",
    "number": "1952555740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1255 N DUTTON AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954014663",
            "telephone_number": "707-546-9400",
            "fax_number": "707-546-9464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1255 N DUTTON AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954014663",
            "telephone_number": "707-546-9400",
            "fax_number": "707-546-9464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA ROSA SPORTS MEDICINE, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-06",
        "last_updated": "2014-10-13",
        "status": "A",
        "authorized_official_last_name": "AFFLECK",
        "authorized_official_first_name": "TY",
        "authorized_official_middle_name": "PRESTON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "707-546-9400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "CA",
            "license": "G073843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Santa Rosa Sports and Family Medicine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Santa Rosa Physical Therapy
• Santa Rosa Postacute Care LLC (Northvine Postacute Care)
• Santa Rosa Speech & Language Services
• Santa Rosa Speech & Language Services
• Santa Rosa Speech Therapy, PC (Santa Rosa Speech and Langauge Services)
• Santa Rosa Surgery Center L P (Santa Rosa Surgery and Endoscopy Center)
• Santa Rosa Surgical Associates
• Santa Rosa Surgical Services LLC
• Santa Rosa Trauma Physicians Medical Group
• Santa Rosa Treatment Program, Inc.

• Sports Medicine (Family Medicine) Physician in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Sports Medicine (Family Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2014; 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.