Unknown Individual – Sports Medicine (Family Medicine) Physician, NPI 1215917042
Excluded from federal healthcare programs (Medicare/Medicaid)
This provider is listed on the OIG List of Excluded Individuals/Entities (LEIE). Exclusion effective: 2017-02-20. Reason: License revocation, suspension, or surrender.
Sports Medicine (Family Medicine) Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
241, North Buffalo Drive, Las Vegas, Clark County, Nevada, 89145, United States
BLDG. 1
LAS VEGAS, NV 891450373
Phone: (702) 876-2225
Fax: (702) 876-9307
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $40.
Total Amount is formed as General ($40) + Research ($0) + Ownership ($0) = $40.
Last reported payment date: 2023-05-23 • Largest payer in this snapshot: Organogenesis Inc. ($40).
Total Amount
$40
General + Research + Ownership
Payments
2
Total payment records
General Amount
$40
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-05-23
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Organogenesis Inc. | $40 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 89145)
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