NPIMap

Organization Active NPI

Performance Health Medical Group, Inc

  • Family Medicine Physician
  • Laguna Hills, CA
National Provider Identifier
1093896862
Registry record updated Mar 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PERFORMANCE HEALTH MEDICAL GROUP, INC
Practice address
25431 Cabot Rd
Suite 118
Laguna Hills, CA 92653-5518
Phone
(949) 362-8877
Fax
(949) 598-8042
NPI assigned
Oct 18, 2006
Last updated
Mar 25, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2009

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

Authorized official

Name
Dr. Brian D Carrico, D.C.
Title
President
Phone
(949) 362-8877

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X NU
Family Medicine Physician 207Q00000X NU Primary
Internal Medicine Physician 207R00000X NU
Orthopaedic Surgery Physician 207X00000X NU
Rehabilitation Chiropractor 111NR0400X NU

Addresses

Primary practice location

25431 Cabot Rd
Suite 118
Laguna Hills, CA 92653-5518

Mailing address

25431 Cabot Rd
Suite 118
Laguna Hills, CA 92653-5518
Phone (949) 362-8877

Other identifiers 1

IdentifierTypeStateIssuer
120115601OtherCAGROUP

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050523001335 CA Part B Supplier - Clinic/Group Practice 4981646676 Receives reassigned benefits from 11 practitioners
Practice locations: Laguna Hills, CA

National Provider Directory

National Provider Directory

Locations

27062 La Paz Rd
Laguna Hills, CA 92656
Phone (949) 362-8877

4849 Van Nuys Blvd
Ste 102
Sherman Oaks, CA 91403
Phone (818) 205-9515

21707 Hawthorne Blvd
Ste 101
Torrance, CA 90503
Phone (310) 540-9699

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237939200000",
    "number": "1093896862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25431 CABOT RD",
            "address_2": "SUITE 118",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926535518",
            "telephone_number": "949-362-8877",
            "fax_number": "949-598-8042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25431 CABOT RD",
            "address_2": "SUITE 118",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926535518",
            "telephone_number": "949-362-8877",
            "fax_number": "949-598-8042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFORMANCE HEALTH MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2009-03-25",
        "status": "A",
        "authorized_official_last_name": "CARRICO",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-362-8877",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP",
            "identifier": "120115601",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laguna Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2009; 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.