| Osu Sports Medicine Center | |
|
2050 Kenny Rd Third Floor Columbus OH 43221-3502 | |
| (614) 293-3600 | |
| (614) 293-4399 |
| Full Name | Osu Sports Medicine Center |
|---|---|
| Speciality | Family Medicine |
| Location | 2050 Kenny Rd, Columbus, Ohio |
| Authorized Official Name and Position | Anne Smith (DIRECTOR, CORPORATE CREDENTIALING) |
| Authorized Official Contact | 6142937443 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Osu Sports Medicine Center 700 Ackerman Rd Ste 570 Columbus OH 43202-1559 Ph: (614) 293-3693 | Osu Sports Medicine Center 2050 Kenny Rd Third Floor Columbus OH 43221-3502 Ph: (614) 293-3600 |
| NPI Number | 1285692228 |
|---|---|
| Provider Enumeration Date | 05/01/2006 |
| Last Update Date | 11/30/2018 |
| Medicare PECOS PAC ID | 5294773636 |
|---|---|
| Medicare Enrollment ID | O20050418000660 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285692228 | NPI | - | NPPES |
| 2546829 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Primary |
| 207XX0005X | Orthopaedic Surgery - Sports Medicine | (* (Not Available)) | Secondary |
| Provider Name | James R Borchers |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1073570107 PECOS PAC ID: 4880675867 Enrollment ID: I20040526000447 |
| Provider Name | Kendra Mccamey |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1922065028 PECOS PAC ID: 0749260396 Enrollment ID: I20040723000245 |
| Provider Name | David Clint Flanigan |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1093771610 PECOS PAC ID: 4880655703 Enrollment ID: I20041025000278 |
| Provider Name | Grant Lloyd Jones |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1740243005 PECOS PAC ID: 8820036056 Enrollment ID: I20050419000992 |
| Provider Name | Christopher C Kaeding |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1912965054 PECOS PAC ID: 2769420918 Enrollment ID: I20050419001165 |
| Provider Name | Clinton A Hartz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194908806 PECOS PAC ID: 9032259601 Enrollment ID: I20091214000261 |
| Provider Name | Michael A Jonesco |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1083800361 PECOS PAC ID: 3678603735 Enrollment ID: I20100616000451 |
| Provider Name | Jackie L Buell |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1992917694 PECOS PAC ID: 0446432918 Enrollment ID: I20110307000008 |
| Provider Name | Timothy L Miller |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1982811352 PECOS PAC ID: 6305023763 Enrollment ID: I20110613000130 |
| Provider Name | Robert A Magnussen |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1366599227 PECOS PAC ID: 5991979890 Enrollment ID: I20111110000294 |
| Provider Name | John M Ryan |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1700053857 PECOS PAC ID: 1557527637 Enrollment ID: I20120717000498 |
| Provider Name | Bryant J Walrod |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811943459 PECOS PAC ID: 5092896001 Enrollment ID: I20140116001878 |
| Provider Name | William Kelton Vasileff |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1144485905 PECOS PAC ID: 9931339181 Enrollment ID: I20150528002354 |
| Provider Name | Kacie Vavrek |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1932586849 PECOS PAC ID: 4587985874 Enrollment ID: I20150611003264 |
| Provider Name | Mark J Conroy |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1295021954 PECOS PAC ID: 8123255395 Enrollment ID: I20150730012283 |
| Provider Name | Nicole Kornder |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053756163 PECOS PAC ID: 6709015977 Enrollment ID: I20160630001300 |
| Provider Name | James Houle |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1306196050 PECOS PAC ID: 1557510781 Enrollment ID: I20160829000798 |
| Provider Name | Steven Michael Albrechta |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1063772739 PECOS PAC ID: 0547407678 Enrollment ID: I20160829001456 |
| Provider Name | Michael R Baria |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1265723621 PECOS PAC ID: 9032365333 Enrollment ID: I20160829001591 |
| Provider Name | Trevor R Kitchin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821431081 PECOS PAC ID: 7214166719 Enrollment ID: I20170628000838 |
| Provider Name | Andrew Neviaser |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1376700773 PECOS PAC ID: 4688845332 Enrollment ID: I20170713002211 |
| Provider Name | Larry R. Nolan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689094625 PECOS PAC ID: 8224326210 Enrollment ID: I20180912002945 |
| Provider Name | Robert Duerr |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1447508189 PECOS PAC ID: 4385931617 Enrollment ID: I20180918002438 |
| Provider Name | Gregory Louis Cvetanovich |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1407118565 PECOS PAC ID: 6305114638 Enrollment ID: I20180920003353 |
| Provider Name | Jonathan Goike |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1356736680 PECOS PAC ID: 9830408368 Enrollment ID: I20190930002304 |
| Provider Name | Margaret F Doe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184078644 PECOS PAC ID: 7517259500 Enrollment ID: I20200901002301 |
| Provider Name | Ryan C Rauck |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1073908984 PECOS PAC ID: 5597037408 Enrollment ID: I20210824000141 |
| Provider Name | Andrew M. Grozenski |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1427552496 PECOS PAC ID: 5698010296 Enrollment ID: I20220606000656 |
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