The Sports Med Spa LLC
NPI 1679453781ActiveOrganization· Physician Assistant· West Jordan, UT
Physician Assistant in West Jordan, Utah, registered in NPPES in September 2025. The authorized official on file is Gibran Borja, Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1679453781 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Sep 8, 2025 |
| Last updated in NPPES | Oct 16, 2025 |
| Certified by provider | Oct 16, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physician Assistant Primary | 363A00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (UT) |
|---|
Other Physician Assistant providers in West Jordan
- 1497485031
- 1225099229
- 1982666475
- 1629038716
- 1881881183
- 1679125934
- 1730429374
- 1053327312
- 1922653971
- 1205899416
- 1487874608
- 1619445053