Primary Care Sports Medicine PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301074786 Issued in MI

Legal business name

PRIMARY CARE SPORTS MEDICINE PC

Practice address

560 W Mitchell St
Suite 340
Petoskey, MI 49770-2275

Phone

(231) 348-9710

Fax

(231) 348-9715

NPI assigned

Jan 25, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Todd M Sheperd, MDNPI 1679597785

Title

President

Phone

(231) 348-9710

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Todd M Sheperd, MD

  • Family Medicine Physician
  • Petoskey, MI
  • NPI 1679597785
  NPD (past) Authorized official
• Gregory C Putalik, M.D.

  • Family Medicine Physician
  • Harbor Springs, MI
  • NPI 1679782841
  NPD (past)

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215475200000",
    "number": "1972658136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 W MITCHELL ST",
            "address_2": "SUITE 340",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702275",
            "telephone_number": "231-348-9710",
            "fax_number": "231-348-9715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 W MITCHELL ST",
            "address_2": "SUITE 340",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702275",
            "telephone_number": "231-348-9710",
            "fax_number": "231-348-9715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE SPORTS MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2008-07-08",
        "status": "A",
        "authorized_official_last_name": "SHEPERD",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-348-9710",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301074786",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104701069",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Powell, MS, OTRL
• Natalia Powell, MA, LPC, NCC
• Powerback Rehabilitation LLC
• Carl F Powers, O.D.
• Rebecca L. Price, PA-C
• Professional Optical LLC
• James P Prokos, PAC
• Psychnorth
• Anthony R Pucci, DO
• Pulver Family Chiropractic PLLC

• Family Medicine Physician in Petoskey, MI
• Providers in Petoskey, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2008; 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.