NPIMap

Organization Active NPI

Sports Conditioning and Rehabilitation of California Inc

  • Physical Therapist
  • Orange, CA
National Provider Identifier
1013047240
Registry record updated Dec 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
SPORTS CONDITIONING AND REHABILITATION OF CALIFORNIA INC
Practice address
871 S Tustin St
Orange, CA 92866-3426
Phone
(714) 633-7227
Fax
(714) 633-9062
NPI assigned
Mar 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Bobby IsmailNPI 1295880656
Title
President
Phone
(209) 353-1988

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

871 S Tustin St
Orange, CA 92866-3426

Mailing address

871 S Tustin St
Orange, CA 92866-3426
Phone (714) 633-7227

Other identifiers 1

IdentifierTypeStateIssuer
PT0175090MedicaidCA

Other names 1

  • STAR CLINIC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080603000327 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2365512365 Receives reassigned benefits from 9 practitioners
Practice locations: Orange, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701820800000",
    "number": "1013047240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "871 S TUSTIN ST",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928663426",
            "telephone_number": "714-633-7227",
            "fax_number": "714-633-9062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "871 S TUSTIN ST",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928663426",
            "telephone_number": "714-633-7227",
            "fax_number": "714-633-9062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTS CONDITIONING AND REHABILITATION OF CALIFORNIA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A",
        "authorized_official_last_name": "ISMAIL",
        "authorized_official_first_name": "BOBBY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-353-1988"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PT0175090",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "STAR CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "STAR CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orange, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.