JACKSONVILLE STATE UNIVERSITY (NPI# 1548717119) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548717119 |
| Entity Type | Organization |
| Organization Name | JACKSONVILLE STATE UNIVERSITY |
| Other Organization Name | JACKSONVILLE STATE UNIVERSITY SPORTS MEDICINE |
| Practice Address |
700 Pelham Rd N Jacksonville AL 36265-1602 |
| Mailing Address |
5050 Spring Valley Rd. Dallas TX 75244-3909 |
| Practice Telephone | 2567825369 |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2016-09-01 |
| Authorized Official Name | MOUZON BASS III (AGENT) |
| Authorized Official Telephone | 9723674845 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
10954 | AL | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Jacksonville State University Sports Medicine | Doing Business As Name - Organization |
| Street Address |
700 PELHAM RD N |
| City | JACKSONVILLE |
| State | AL |
| Zip Code | 36265-1602 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669882569 | Makenzie W. Bayles | Behavioral Analyst | 700 Pelham Rd N, Jsu - Psychology Department, Jacksonville, AL 36265-1602 | 2014-04-30 |
| 1487297065 | Christopher Marvin Clark | Specialist/Technologist | 700 Pelham Rd N, Jacksonville, AL 36265-1602 | 2019-10-25 |
| 1568026375 | Rebecca Katherine Nation | Specialist/Technologist | 700 Pelham Rd N, Jacksonville, AL 36265-1623 | 2019-04-26 |
| 1912486929 | Savannah Rose Barrentine | Specialist/Technologist | 700 Pelham Rd N, Jacksonville, AL 36265-1602 | 2018-08-09 |
| 1104336627 | Michael Garrett Polascik | Specialist/Technologist | 700 Pelham Rd N, Jacksonville, AL 36265-1602 | 2017-10-11 |
| 1275043895 | Michaela Grace Meadows | Physical Medicine & Rehabilitation | 700 Pelham Rd N, Jacksonville, AL 36265-1602 | 2017-10-10 |
| 1497264659 | Jonathan Griffith | Specialist/Technologist | 700 Pelham Rd N, Jacksonville, AL 36265-1602 | 2017-09-20 |
| 1003325275 | Jenah Tracy | Specialist/Technologist | 700 Pelham Rd N, Jacksonville, AL 36265-1602 | 2017-09-20 |
| 1275042426 | Dustin Hill | Specialist/Technologist | 700 Pelham Rd N, Jacksonville, AL 36265-1602 | 2017-09-20 |
| 1346776952 | Summer Allen | Prevention Professional | 700 Pelham Rd N, Jacksonville, AL 36265-1602 | 2017-05-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700436144 | Griffin Loflin | Specialist/Technologist | 775 Park Ave Nw, Attn. Sports Medicine, Jacksonville, AL 36265 | 2019-09-17 |
| 1114304011 | Caroline Ross | Counselor | 1215 Jackson Way Sw, Jacksonville, AL 36265 | 2015-04-29 |
| 1083001226 | Tracey Hudgins | Counselor | 1215 Jackson's Way, Jacksonville, AL 36265 | 2015-04-24 |
| 1235415118 | Adam Pike | Pharmacist | 311 Pelham Rd So, Jacksonville, AL 36265 | 2011-10-24 |
| 1386829489 | Physicians Choice Dialysis of Jacksonville, LLC | Clinic/Center | 331 Henry Road Sw, Jacksonville, AL 36265 | 2008-01-08 |
| 1659409365 | Kenneth Wayne Campbell | Nurse Anesthetist, Certified Registered | 1701 Pelham Road, Jacksonville Medical Center, Jacksonville, AL 36265 | 2007-03-02 |
| 1154478378 | Diana C. Ford | Counselor | 1250 Jackson's Way, Garrett Counseling Center, Jacksonville, AL 36265 | 2007-01-03 |
| 1487710950 | James Richard Morrison | Chiropractor | 1550 Pelham Rd. S., Jacksonville, AL 36265 | 2006-12-29 |
| 1447332937 | Millennium Anesthesia Services | Anesthesiology | 1701 Pelham Road S, Jacksonville, AL 36265 | 2006-10-20 |
| 1407943228 | Brunda Revanna, Md | Clinic/Center | 1465 A 1st Ave Sw Ste C, Jacksonville, AL 36265 | 2006-10-05 |
| Find all providers in zip 36265 | ||||
| Taxonomy Code | 207QS0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Sports Medicine |
| A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://www.theabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396938171 | Lawrence M Linett, Md, Pllc | Family Medicine | 431 Western Blvd Ste E, Jacksonville, NC 28546-6823 | 2007-08-24 |
| 1083795637 | Haghighi Family & Sports Medicine Pa | Family Medicine | 9191 Rg Skinner Prkwy, Suite 901, Jacksonville, FL 32256 | 2006-10-18 |
| 1891733952 | Om P Kapoor | Family Medicine | 4131 University Blvd S Ste 3, Jacksonville, FL 32216-4346 | 2006-06-02 |
| 1437116464 | Robert Paul Martin | Family Medicine | 7963 Normandy Blvd, Jacksonville, FL 32221-6640 | 2006-04-26 |
| 1528042496 | Ross Quinn Osborn | Family Medicine | 115 Bartram Oaks Walk, Suite 104, Jacksonville, FL 32259-3243 | 2005-12-02 |
| 1710413562 | Tyler Jordan Schmitz | Family Medicine | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2017-05-11 |
| 1871989152 | Michael Stiller | Family Medicine | 4500 San Pablo Rd S, Jacksonville, FL 32224 | 2015-04-13 |
| 1700291333 | Raul Alejandro Rosario-concepcion | Family Medicine | 4500 San Pablo Rd S, Jacksonville, FL 32224 | 2014-06-23 |
| 1972914174 | Scott Marberry | Family Medicine | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2014-05-11 |
| 1841580370 | Matthew Lunser | Family Medicine | 4500 San Pablo Rd S, Mayo Clinic - Family Medicine Department, Jacksonville, FL 32224-1865 | 2011-04-18 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 36265 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.