Espanola Sports Medicine is a medicare enrolled "Clinic/center - Rehabilitation" provider in Espanola, New Mexico. Their current practice location is
708 La Joya St, Espanola, New Mexico. You can reach out to their office (for appointments etc.) via phone at
(505) 753-6550.
Espanola Sports Medicine is licensed to practice in * (Not Available) (license number ) and it also participates in the medicare program. Espanola Sports Medicine
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1982777850.
Healthcare Provider's Profile
| Full Name | Espanola Sports Medicine |
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| Type | Facility |
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| Speciality | Clinic/center - Rehabilitation |
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| Location | 708 La Joya St, Espanola, New Mexico |
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| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1982777850
- Provider Enumeration Date: 11/16/2006
- Last Update Date: 10/31/2023
Medicare PECOS Information:
- PECOS PAC ID: 2163691411
- Enrollment ID: O20141114001053
Medical Identifiers
Medical identifiers for Espanola Sports Medicine such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1982777850 | NPI | - | NPPES |
| R5803 | Medicaid | NM | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 225100000X | Physical Therapist | 6628 (New Mexico) | Secondary |
| 261QP2000X | Clinic/center - Physical Therapy | 6628 (New Mexico) | Secondary |
| 261QR0400X | Clinic/center - Rehabilitation | (* (Not Available)) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Espanola Sports Medicine acts as a billing entity for following providers:
| Provider Name | Marian C Bradbury |
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| Provider Type | Practitioner - Physical Therapist In Private Practice |
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| Provider Identifiers | NPI Number: 1942324900
PECOS PAC ID: 6507188216
Enrollment ID: I20141209000669 |
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| Provider Name | Amanda R Vander Wiel |
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| Provider Type | Practitioner - Occupational Therapist In Private Practice |
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| Provider Identifiers | NPI Number: 1700449931
PECOS PAC ID: 4082030150
Enrollment ID: I20200819003469 |
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| Provider Name | Tara Terrazas |
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| Provider Type | Practitioner - Physical Therapist In Private Practice |
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| Provider Identifiers | NPI Number: 1891562674
PECOS PAC ID: 6002268273
Enrollment ID: I20240124000031 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Espanola Sports Medicine is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Espanola Sports Medicine
708 La Joya St,
Espanola, NM 87532-2511
Ph: (505) 753-6550 | Espanola Sports Medicine
708 La Joya St,
Espanola, NM 87532-2511
Ph: (505) 753-6550 |
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