Orthocincy Orthopaedics & Sports Medicine PSC
Organization Active NPI Orthopaedic Surgery Physician · Highland Heights, KY
NPI 1992336853 · NPPES record last updated Aug 26, 2022
Key facts
- NPI
- 1992336853
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Orthopaedic Surgery Physician 207X00000X
- Legal business name
- ORTHOCINCY ORTHOPAEDICS & SPORTS MEDICINE PSC
- Practice address
- 2626 Alexandria Pike Ste 100
Highland Heights, KY 41076-1530 - Phone
- (859) 301-2663
- Fax
- (859) 817-7848
- NPI assigned
- Jan 30, 2020
- Organization subpart
- No
Authorized official
- Name
- Joann Marie Reis
- Title
- Ceo
- Phone
- (859) 301-2663
Other NPIs with the same Medicare PAC ID 14
Corporate family (same tax ID) 16
Practitioners 164
-
Ana Carolina B Baptista Wise, MSN, RN
-
Maria Elizabeth Beane, PT, DPT
-
Jared Allen Blank, DPT
-
David A Boyce, PT, OCS, ECS, EDD
-
Jenna Burns, PA-C
-
Timothy Michael Burns, D.O.
-
Joshua Coger, D.P.M.
-
Matthew James Connolly, D.P.M.
-
Emily Michelle Dean, DPT
-
Joseph Zachary Dedden, P.A.
-
Camryn Joanna Diebold, PT, DPT
-
Thomas Mark Due, MD
-
Bradley Dunkin, MD
-
Taylor Durbin, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D2180662 | Orthocincy Orthopaedics and Sports Medicine | Certificate of waiver | Mar 17, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200420002575 | KY | DME Supplier - Physician - Unknown Physician Specialty | 3173500196 | Practice locations: Highland Heights, KY |
National Provider Directory
- Tax ID family
- Orthocincy Orthopaedics Sports Medicine PSC
Locations
2626 Alexandria Pike
Ste 300
Highland Heights, KY 41076
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Family Medicine) Physician |
207QS0010X | |||
| Internal Medicine Physician |
207R00000X | |||
| Magnetic Resonance Imaging (MRI) Internal Medicine Physician |
207RM1200X | |||
| Sports Medicine (Internal Medicine) Physician |
207RS0010X | |||
| Orthopaedic Surgery Physician |
207X00000X | Yes | ||
| Orthopaedic Hand Surgery Physician |
207XS0106X | |||
| Adult Reconstructive Orthopaedic Surgery Physician |
207XS0114X | |||
| Sports Medicine (Orthopaedic Surgery) Physician |
207XX0005X | |||
| Sports Medicine (Physical Medicine & Rehabilitation) Physician |
2081S0010X | |||
| Podiatrist |
213E00000X | |||
| Physical Therapist |
225100000X | |||
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Physician Assistant |
363A00000X | |||
| Nurse Practitioner |
363L00000X | |||
| Family Nurse Practitioner |
363LF0000X |
Addresses
Primary practice location
2626 Alexandria Pike Ste 100
Highland Heights, KY 41076-1530
Mailing address
560 S Loop Rd
Edgewood, KY 41017-3405
Phone (859) 301-2663
Other providers in Highland Heights, KY
- Northern Kentucky Dental Care Partners LLC
- Northern Kentucky Pediatric Group PSC
- Northern Kentucky University
- Aaron W. Ornburn
- Jamie Nicole Ornburn
- Ted George Pappas
- Richard Troy Peace
- Bernadette T Peak
- Daryl Jason Peak
- Kathryn Alexis Perkins
All providers in Highland Heights, KY · Orthopaedic Surgery Physician in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 26, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.