MEDICARE: PRIMARY CARE SPORTS MEDICINE A MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RS0010X	Sports Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1841977253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY CARE SPORTS MEDICINE A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	29229 CANWOOD ST STE 112
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-1561
Country	:	US
Telephone Number	:	818-501-7276
Fax Number	:	818-921-7702

Provider Business Practice Location Address
First Line	:	29229 CANWOOD ST STE 112
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-1561
Country	:	US
Telephone Number	:	818-501-7276
Fax Number	:	818-501-7288

Authorized Official
Title or Position	:	CEO
Name	:	BYRON PATTERSON
Credential	:
Telephone Number	:	818-501-7276

Provider Enumeration Date	:	06/28/2023
Last Update Date	:	01/08/2026

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