NPIMap

Organization Active NPI

Repair NB Physical Therapy, Corp

  • Physical Therapist
  • Newport Beach, CA
National Provider Identifier
1134622111
Registry record updated Mar 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
REPAIR NB PHYSICAL THERAPY, CORP
Practice address
20311 SW Birch St Ste 150
Newport Beach, CA 92660-1779
Phone
(714) 377-4314
NPI assigned
Mar 15, 2018
Last updated
Mar 15, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2018

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

Authorized official

Name
Chad BeauchampNPI 1639459480
Title
Owner
Phone
(714) 377-4314

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 Therapist 225100000X NU Primary

Addresses

Primary practice location

20311 SW Birch St Ste 150
Newport Beach, CA 92660-1779

Mailing address

PO Box 1122
Rhinelander, WI 54501-1122

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190731003639 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2860732922 Receives reassigned benefits from 13 practitioners
Practice locations: Huntington Beach, CA

National Provider Directory

National Provider Directory

Locations

7146 Edinger Ave
Huntington Beach, CA 92647
Phone (714) 377-4314

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1521072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521072000000",
    "number": "1134622111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1122",
            "city": "RHINELANDER",
            "state": "WI",
            "postal_code": "545011122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20311 SW BIRCH ST STE 150",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926601779",
            "telephone_number": "714-377-4314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REPAIR NB PHYSICAL THERAPY, CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-15",
        "last_updated": "2018-03-15",
        "status": "A",
        "authorized_official_last_name": "BEAUCHAMP",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-377-4314"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2018; 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.