JACKSONVILLE STATE UNIVERSITY SPORTS MEDICINE (JACKSONVILLE STATE UNIVERSITY) NPI 1548717119

Family Medicine (Sports Medicine) in Jacksonville, AL

NPI 1548717119 Organization Family Medicine Sports Medicine CLIA Number 01D2201235 CLIA Certificate of Waiver

About JACKSONVILLE STATE UNIVERSITY SPORTS MEDICINE (JACKSONVILLE STATE UNIVERSITY)

Jacksonville State University Sports Medicine (jacksonville State University) is a primary care provider established in Jacksonville, Alabama specializing in family medicine (sports medicine) . The NPI number of Jacksonville State University Sports Medicine (jacksonville State University) is 1548717119 and was assigned on September 2016. The practitioner's primary taxonomy code is 207QS0010X with license number 10954 (AL). The provider is registered as an organization and their NPI record was last updated 5 years ago. Jacksonville State University Sports Medicine (jacksonville State University) operates as a multi-specialty business group with one or more individual providers who practice different areas of specialization. The provider's is doing business as Jacksonville State University Sports Medicine. The authorized official of this NPI record is Mouzon Bass Iii (Agent)

A primary care provider (PCP) like Jacksonville State University Sports Medicine sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc

The CLIA number of Jacksonville State University Sports Medicine is 01D2201235 registered as a "school/student health service" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Jacksonville State University Sports Medicine to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI

1548717119

Provider NameJACKSONVILLE STATE UNIVERSITY SPORTS MEDICINE (JACKSONVILLE STATE UNIVERSITY)
Provider Location Address700 PELHAM RD N JACKSONVILLE, AL 36265
Provider Mailing Address5050 SPRING VALLEY RD. DALLAS, TX 75244
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NameJACKSONVILLE STATE UNIVERSITY SPORTS MEDICINE
Other Name TypeDoing Business As (3)
Enumeration Date09-01-2016
Last Update Date09-01-2016


Primary Taxonomy

Taxonomy Code207QS0010X
ClassificationFamily Medicine
TypeAllopathic & Osteopathic Physicians
SpecializationSports Medicine
License No.10954
License StateAL
Taxonomy DescriptionA 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.

Business Address

JACKSONVILLE STATE UNIVERSITY SPORTS MEDICINE
700 PELHAM RD N
JACKSONVILLE, AL
ZIP 36265
Phone: (256) 782-5369

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Mailing Address

JACKSONVILLE STATE UNIVERSITY SPORTS MEDICINE
5050 SPRING VALLEY RD.
DALLAS, TX
ZIP 75244
Phone:



Authorized Official

Authorized Official Name MOUZON BASS III
Authorized Official TitleAGENT
Authorized Official Phone(972) 367-4845

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1548717119 is:

CLIA Number01D2201235
Facility TypeSCHOOL/STUDENT HEALTH SERVICE
Certificate TypeCertificate of Waiver

Group Taxonomy


193200000X MULTI-SPECIALTY GROUP - This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.

Other Providers at the same location


The following 14 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1669882569 MAKENZIE W. BAYLES PH.D, BCBA-D
Individual
Behavior Analyst700 PELHAM RD N JSU - PSYCHOLOGY DEPARTMENT
JACKSONVILLE, AL 36265
(256) 782-5809
1679967160 JENNIFER WILMES
Individual
Specialist/Technologist (Athletic Trainer)700 PELHAM RD N ATTN: FIELD HOUSE
JACKSONVILLE, AL 36265
(256) 782-5369
1346776952 SUMMER ALLEN ATC
Individual
Prevention Professional700 PELHAM RD N
JACKSONVILLE, AL 36265
(256) 782-5526
1497264659 JONATHAN GRIFFITH ATC, LAT
Individual
Specialist/Technologist (Athletic Trainer)700 PELHAM RD N
JACKSONVILLE, AL 36265
(256) 782-5526
1003325275 JENAH TRACY
Individual
Specialist/Technologist (Athletic Trainer)700 PELHAM RD N
JACKSONVILLE, AL 36265
(239) 227-9632
1275042426 DUSTIN HILL ATC, LAT
Individual
Specialist/Technologist (Athletic Trainer)700 PELHAM RD N
JACKSONVILLE, AL 36265
(256) 782-5369
1275043895 MICHAELA GRACE MEADOWS ATC, LAT
Individual
Physical Medicine & Rehabilitation (Sports Medicine)700 PELHAM RD N
JACKSONVILLE, AL 36265
(256) 782-5526
1104336627 MICHAEL GARRETT POLASCIK ATC
Individual
Specialist/Technologist (Athletic Trainer)700 PELHAM RD N
JACKSONVILLE, AL 36265
(256) 782-5369
1912486929 SAVANNAH ROSE BARRENTINE
Individual
Specialist/Technologist (Athletic Trainer)700 PELHAM RD N
JACKSONVILLE, AL 36265
(256) 782-5781
1487297065 CHRISTOPHER MARVIN CLARK ATC
Individual
Specialist/Technologist (Athletic Trainer)700 PELHAM RD N
JACKSONVILLE, AL 36265
(256) 782-5514
1568026375 REBECCA KATHERINE NATION LAT, ATC
Individual
Specialist/Technologist (Athletic Trainer)700 PELHAM RD N
JACKSONVILLE, AL 36265
(256) 782-5369
1568017754 OLIVIA KEEFE MS, LAT, ATC
Individual
Specialist/Technologist (Athletic Trainer)700 PELHAM RD N
JACKSONVILLE, AL 36265
(508) 641-8517
1871900605DR. JENNIFER LAUREN SAVAGE PHD LAT ATC
Individual
Health Educator700 PELHAM RD N
JACKSONVILLE, AL 36265
(256) 782-5428
1609394279 KATHRYN ADCOCK
Individual
Specialist/Technologist (Athletic Trainer)700 PELHAM RD N
JACKSONVILLE, AL 36265
(256) 782-5526

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.