Spine & Sports Medical Center – Sports Medicine (Physical Medicine & Rehabilitation) Physician, NPI 1407032782
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Spine & Sports Medical Center
3070 College St Ste 406
Beaumont, TX 777014688
Phone: (409) 434-4735
Fax: (409) 434-4741
Type: Location
610, Strickland Drive, Orange, Orange County, Texas, 77630, United States
SUITE 320
ORANGE, TX 776304786
Phone: (409) 883-5300
Fax: (409) 883-5394
Type: Location
6901 MEDICAL CENTER DR STE 230
ORANGE, TX 776301407
Phone: (409) 883-5300
Fax: (409) 883-5394
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2012-04-04
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-10-31 (590 days ago).
Enrollment records
1
Earliest due date
2024-10-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20120404000662 | O | Clinic/Group Practice | TX | 2024-10-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
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 77701)
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