NPIMap

Organization Active NPI

Laguna Beach Rehab, Inc.

Doing business as Corona del Mar Rehab, Inc

  • Clinic/Center
  • Newport Beach, CA
National Provider Identifier
1164466785
Registry record updated Oct 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
BT00015281 Issued in CA
Legal business name
LAGUNA BEACH REHAB, INC.
Doing business as
Corona del Mar Rehab, Inc
Corona del Mar Rehab, Inc.
Practice address
1441 Avocado Ave Ste 307
Newport Beach, CA 92660-7704
Phone
(949) 640-2121
Fax
(949) 640-2631
NPI assigned
Jun 15, 2006
Last updated
Oct 7, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2022

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

Authorized official

Name
Mr. Brian R Fracalosy
Title
H.R. Manager
Phone
(949) 640-2121

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X BT00015281 CA Primary
Rehabilitation Clinic/Center 261QR0400X NU

Addresses

Primary practice location

1441 Avocado Ave Ste 307
Newport Beach, CA 92660-7704

Mailing address

1441 Avocado Ave Ste 307
Newport Beach, CA 92660-7704
Phone (949) 640-2121

Other identifiers 1

IdentifierTypeStateIssuer
W19811OtherCAMEDICARE, PTAN

Other names 2

  • Corona del Mar Rehab, Inc Doing business as
  • Corona del Mar Rehab, Inc. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060615000176 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 4688686538 Receives reassigned benefits from 16 practitioners
1 other NPI on this enrollment
Practice locations: Laguna Beach, CA; Newport Beach, CA
O20200124001954 CA DME Supplier - Independently-Practicing Physical TherapistDME Supplier - Independently-Practicing Occupational Therapist 4688686538 Practice locations: Newport Beach, CA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

2600 Pacific Coast Hwy
Ste 150
Corona del Mar, CA 92625
Phone (949) 640-2121

2600 Pacific Coast Hwy
Ste 240
Corona del Mar, CA 92625
Phone (949) 640-2121

30836 Coast Hwy
Laguna Beach, CA 92651
Phone (949) 499-9559

Practitioners & affiliated clinicians

Practitioners 31

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 31

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665100800000",
    "number": "1164466785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 AVOCADO AVE STE 307",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607704",
            "telephone_number": "949-640-2121",
            "fax_number": "949-640-2631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 AVOCADO AVE STE 307",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607704",
            "telephone_number": "949-640-2121",
            "fax_number": "949-640-2631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAGUNA BEACH REHAB, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-15",
        "last_updated": "2022-10-07",
        "certification_date": "2022-10-07",
        "status": "A",
        "authorized_official_last_name": "FRACALOSY",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "H.R. MANAGER",
        "authorized_official_telephone_number": "949-640-2121",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "BT00015281",
            "primary": true
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE, PTAN",
            "identifier": "W19811",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Corona del Mar Rehab, Inc",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Corona del Mar Rehab, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Oct 7, 2022; 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.