Kevin T. DO, M.D.

Primary specialty

Neuromuscular Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081N0008X

License

G76640 Issued in CA

Practice address

14161 Newport Ave
Tustin, CA 92780-5161

Phone

(818) 288-2757

NPI assigned

Oct 14, 2008

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Premier Wellness Medical Center

  • Physical Therapist
  • Tustin, CA
  • NPI 1114179892
  NPD (past) Authorized official
• Dr. Gregory a. Smith, MD Inc.

  • Pain Medicine (Anesthesiology) Physician
  • Fresno, CA
  • NPI 1760835086
  NPD (past)
• Helius Hospice and Palliative Care, Inc.

  • Community Based Hospice Care Agency
  • North Hollywood, CA
  • NPI 1396330957
  NPD (past)

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

{
    "created_epoch": "1223942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692144000000",
    "number": "1104078880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14191 NEWPORT AVE.",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "92780",
            "telephone_number": "714-508-7333",
            "fax_number": "714-508-7305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14161 NEWPORT AVE",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927805161",
            "telephone_number": "818-288-2757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DO",
        "first_name": "KEVIN",
        "middle_name": "T.",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-10-14",
        "last_updated": "2023-08-16",
        "certification_date": "2023-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081N0008X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Neuromuscular Medicine",
            "state": "CA",
            "license": "G76640",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104078880",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dispatchhealth-Ca, PC
• Evelyn Divinagracia, M.S. CCC-SLP
• John Djerbaka, P.T.
• Carmen C DO, COTA
• Jacqueline Thanhhuyen DO, M.D.
• Peter DO, PHARMD
• Teresa DO
• Duc Ngoc Doan, PHARMD
• Docs for(4) Kids Medical Office
• Dodam Acupuncture Clinic Inc

• Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician in Tustin, CA
• Providers in Tustin, CA by specialty
• Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.