Willis Mark Sutcliff, MPT, ATC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT26858 Issued in CA

Practice address

255 N Tustin St
Orange, CA 92867-7772

Phone

(714) 288-9125

Fax

(714) 288-9129

NPI assigned

Jul 23, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Impact Rehabilitation Center IncGroup PAC ID 3375681356, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Impact Rehabilitation Center Inc

  • Specialist
  • Orange, CA
  • NPI 1801817739

  Physical Therapist

  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1153612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073534905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5986",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928635986",
            "telephone_number": "714-288-9125",
            "fax_number": "714-288-9129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 N TUSTIN ST",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928677772",
            "telephone_number": "714-288-9125",
            "fax_number": "714-288-9129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTCLIFF",
        "first_name": "WILLIS",
        "middle_name": "MARK",
        "credential": "MPT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT26858",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PT0268580",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Josefina Surrett, OT
• Susan Debin MD Inc.
• Jade Sustacek
• Angie B Sustaeta-Vazquez
• Diana Finn Sutcliff, DPT
• Joyce Angeline Sutedja, M.D.
• Amina Iheoma Sutherland-Stolting, M.D.
• M. Linda Sutherland, M.D.
• Cori Xiu Yue Sutton
• Emily S Sutton

• Physical Therapist in Orange, CA
• Providers in Orange, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.