NPIMap

Organization Active NPI

Torrance Orthopaedic and Sports Medicine Group

Doing business as CoastalOrtho

  • Orthopaedic Surgery Physician
  • Torrance, CA
National Provider Identifier
1104864131
Registry record updated Jul 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
22653 Issued in CA
Legal business name
TORRANCE ORTHOPAEDIC AND SPORTS MEDICINE GROUP
Doing business as
CoastalOrtho
Practice address
5215 Torrance Blvd Ste 210
Torrance, CA 90503-4009
Phone
(310) 316-6190
Fax
(310) 540-7362
NPI assigned
Jun 3, 2006
Last updated
Jul 23, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2020

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

Authorized official

Name
Diana A Amezola
Title
Billing Manager
Phone
(310) 316-6190

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X 22653 CA Primary

Addresses

Primary practice location

5215 Torrance Blvd Ste 210
Torrance, CA 90503-4009

Mailing address

5215 Torrance Blvd Ste 210
Torrance, CA 90503-4009
Phone (310) 316-6190

Other practice location 1

2200 E Maple Ave
El Segundo, CA 90245-6507
Phone (310) 316-6190

Other names 1

  • CoastalOrtho Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070629000564 CA Part B Supplier - Clinic/Group Practice 8123127255 Receives reassigned benefits from 13 practitioners
Practice locations: Torrance, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595462400000",
    "number": "1104864131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5215 TORRANCE BLVD STE 210",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905034009",
            "telephone_number": "310-316-6190",
            "fax_number": "310-540-7362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5215 TORRANCE BLVD STE 210",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905034009",
            "telephone_number": "310-316-6190",
            "fax_number": "310-540-7362"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2200 E Maple Ave",
            "address_purpose": "LOCATION",
            "city": "El Segundo",
            "state": "CA",
            "postal_code": "902456507",
            "country_code": "US",
            "telephone_number": "310-316-6190",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TORRANCE ORTHOPAEDIC AND SPORTS MEDICINE GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2020-07-23",
        "certification_date": "2020-07-23",
        "status": "A",
        "authorized_official_last_name": "AMEZOLA",
        "authorized_official_first_name": "DIANA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "310-316-6190"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "22653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CoastalOrtho",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Torrance, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2020; 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.