CONCORD UNIVERSITY (NPI# 1033601943) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033601943 |
| Entity Type | Organization |
| Organization Name | CONCORD UNIVERSITY |
| Other Organization Name | CONCORD SPORTS MEDICINE |
| Practice Address |
1000 Vermillion St Athens WV 24712-9027 |
| Mailing Address |
5050 Spring Valley Rd Dallas TX 75244-3995 |
| Practice Telephone | 9723674845 |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2018-06-06 |
| Authorized Official Name | MOUZON BASS III (ADMINISTRATOR) |
| Authorized Official Telephone | 9723674845 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207PS0010X |
Emergency Medicine Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Concord Sports Medicine | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194287565 | Concord University | Physician Assistant | 1000 Vermillion St, Athens, WV 24712-9027 | 2019-04-03 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | CONCORD UNIVERSITY | 1000 Vermillion St, Athens, WV 24712-9027 |
| System for Award Management (SAM) Entities | CONCORD UNIVERSITY RESEARCH AND DEVELOPMENT CORPORATION | 1000 Vermillion St, Athens, WV 24712-9027 |
| Street Address |
1000 VERMILLION ST |
| City | ATHENS |
| State | WV |
| Zip Code | 24712-9027 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609158559 | John Charles Roberts Jr. | Specialist/Technologist | 1000 Vermillion St, Concord University, Athens, WV 24712-9027 | 2011-09-16 |
| 1407487762 | Taylor Isabelle Walker | Specialist/Technologist | 1000 Vermillion St, Athens, WV 24712-9027 | 2020-01-27 |
| 1255962502 | Katelyn Golinsky | Specialist/Technologist | 1000 Vermillion St, Athens, WV 24712-9027 | 2020-01-27 |
| 1881225134 | Lauren Richardson | Student in an Organized Health Care Education/Training Program | 1000 Vermillion St, Athens, WV 24712-9027 | 2020-01-27 |
| 1962033217 | Kaitlyn Stewart | Specialist/Technologist | 1000 Vermillion St, Athens, WV 24712-9027 | 2020-01-27 |
| 1508497868 | Lauren Nicole Kerekes | Specialist/Technologist | 1000 Vermillion St, Athens, WV 24712-9027 | 2020-01-27 |
| 1417588773 | Jesse Lilly | Specialist/Technologist | 1000 Vermillion St, Athens, WV 24712-9027 | 2020-01-27 |
| 1548809312 | Armando S. Frutos Jr. | Specialist/Technologist | 1000 Vermillion St, Athens, WV 24712-9027 | 2019-12-27 |
| 1073151858 | Taylor Rae Thompson | Specialist/Technologist | 1000 Vermillion St, Athens, WV 24712-9027 | 2019-12-12 |
| 1194287565 | Concord University | Physician Assistant | 1000 Vermillion St, Athens, WV 24712-9027 | 2019-04-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649771809 | Brandy Lea Morrison | Specialist/Technologist | Concord University 1000 Vemillion Street, Athens, WV 24712 | 2018-02-23 |
| 1801330915 | Cami Maxwell | Nurse Practitioner | 274 Nelsie Lane, Athens, WV 24712 | 2016-12-08 |
| 1073056529 | Tracy Leigh Mccallister Gill | Specialist/Technologist | 1000 Vermillion St., Athens, WV 24712 | 2016-11-30 |
| 1578789731 | Natasha Nicola Barker | Physician Assistant | 401 Vermillion Street, Athens, WV 24712 | 2007-04-17 |
| 1508969262 | West Virginia Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 105 South State St, Athens, WV 24712 | 2006-09-07 |
| 1972610863 | Princeton Community Hospital Assn., Inc | Family Medicine | 401 Vermillion St., Athens, WV 24712 | 2006-08-24 |
| 1295763050 | Jennifer Lynn Hvozdovic Koerber | Specialist/Technologist | 1000 Vermillion Street, Campus Box 77, Athens, WV 24712 | 2006-06-29 |
| 1265889844 | Mark Allen Yost | Family Medicine | 401 Vermillion Street, Athens, WV 24712-0697 | 2016-05-24 |
| 1801996657 | Charles Edward Lane Jr. | Dentist | State Route 20 North, Athens, WV 24712-0915 | 2006-09-22 |
| 1972110781 | Jessica Ann Thompson | Technician | 110 Vermillion St Apt 8, Athens, WV 24712-1130 | 2020-09-25 |
| Find all providers in zip 24712 | ||||
| Taxonomy Code | 207PS0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| Specialization | Sports Medicine |
| An emergency physician with special knowledge in sports medicine is responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention and management of injury and illness. A sports medicine physician has knowledge and experience in the promotion of wellness and the role of exercise in promoting a healthy lifestyle. Knowledge of exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation and epidemiology is essential to the practice of sports medicine. |
| 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 Emergency Medicine, 2007. http://www.abem.org/public/. American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427605005 | Jubilee Grace Herrs | Emergency Medicine | 100 Smith St, Athens, GA 30602-1505 | 2019-08-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649726373 | Erin Nicole Wingate | Emergency Medicine | 2828 1st Ave., Huntington, WV 25702 | 2016-09-01 |
| 1023531449 | Kyle Group Pllc | Emergency Medicine | 1007 S Oakwood Ave, Beckley, WV 25801-5977 | 2017-07-18 |
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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.