Active NPI
Ohio Sports & Spine Institute, LTD
- Sports Medicine (Neuromusculoskeletal Medicine) Physician
- Boardman, OH
National Provider Identifier
1962455196
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Neuromusculoskeletal Medicine) Physician
- License
- OH34004337
- Legal business name
- OHIO SPORTS & SPINE INSTITUTE, LTD
- Practice address
- 1265 Boardman Canfield Rd
Boardman, OH 44512-4004 - Phone
- (330) 758-9400
- Fax
- (330) 726-8676
- NPI assigned
- May 18, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Laurie Kleeh, CPA
- Title
- Practice Manager
- Phone
- (330) 758-9400
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Neuromusculoskeletal Medicine) Physician | 204C00000X | OH34004337 | OH | Primary |
Addresses
Primary practice location
1265 Boardman Canfield Rd
Boardman, OH 44512-4004
Mailing address
1265 Boardman Canfield Rd
Boardman, OH 44512-4004
Phone (330) 758-9400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031210000261 | OH | Part B Supplier - Clinic/Group Practice | 6800792938 |
Receives reassigned benefits from 15 practitioners Practice locations: Boardman, OH; East Liverpool, OH; Warren, OH |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 24
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Sports Physician Chiropractor
- Boardman, OH
- NPI 1275933608
OH
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147910400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1607385600000",
"number": "1962455196",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1265 BOARDMAN CANFIELD RD",
"city": "BOARDMAN",
"state": "OH",
"postal_code": "445124004",
"telephone_number": "330-758-9400",
"fax_number": "330-726-8676"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1265 BOARDMAN CANFIELD RD",
"city": "BOARDMAN",
"state": "OH",
"postal_code": "445124004",
"telephone_number": "330-758-9400",
"fax_number": "330-726-8676"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OHIO SPORTS & SPINE INSTITUTE, LTD",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-18",
"last_updated": "2020-12-08",
"certification_date": "2020-12-08",
"status": "A",
"authorized_official_last_name": "KLEEH",
"authorized_official_first_name": "LAURIE",
"authorized_official_title_or_position": "PRACTICE MANAGER",
"authorized_official_telephone_number": "330-758-9400",
"authorized_official_credential": "CPA"
},
"taxonomies": [
{
"code": "204C00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Neuromusculoskeletal Medicine, Sports Medicine",
"state": "OH",
"license": "OH34004337",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boardman, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2020; 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.