NPIMap

Organization Active NPI

Orthopedic & Sports Medicine Center

  • Orthopaedic Surgery Physician
  • Normal, IL
National Provider Identifier
1972611044
Registry record updated Mar 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
042-616684 Issued in IL
Legal business name
ORTHOPEDIC & SPORTS MEDICINE CENTER
Practice address
2200 Fort Jesse Rd Ste 250
Normal, IL 61761-6290
Phone
(309) 454-1616
NPI assigned
Aug 28, 2006
Last updated
Mar 23, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2011

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

Authorized official

Name
Stephen Stout
Title
Chief Operating Officer
Phone
(309) 454-1616

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 042-616684 IL Primary

Addresses

Primary practice location

2200 Fort Jesse Rd Ste 250
Normal, IL 61761-6290

Mailing address

PO Box 1645
Bloomington, IL 61702-1645

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300838400000",
    "number": "1972611044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1645",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617021645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 FORT JESSE RD STE 250",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617616290",
            "telephone_number": "309-454-1616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPEDIC & SPORTS MEDICINE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-28",
        "last_updated": "2011-03-23",
        "status": "A",
        "authorized_official_last_name": "STOUT",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "309-454-1616"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "IL",
            "license": "042-616684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Normal, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2011; 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.