Individual provider Active NPI

Cameron Craver, PT, DPT

  • Orthopedic Physical Therapist
  • Costa Mesa, CA
National Provider Identifier
1174201099
Registry record updated May 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
070.026600 Issued in IL
Practice address
2777 Bristol St Ste B
Costa Mesa, CA 92626-5997
Phone
(949) 250-1112
NPI assigned
Jul 10, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X 304632 CA
Orthopedic Physical Therapist 2251X0800X 070.026600 IL Primary

Addresses

Primary practice location

2777 Bristol St Ste B
Costa Mesa, CA 92626-5997

Mailing address

2777 Bristol St Ste B
Costa Mesa, CA 92626-5997

Other practice location 1

5700 S Cicero Ave Ste 100
Chicago, IL 60638-3831
Phone (630) 856-8682

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231023001449 CA Practitioner - Physical Therapist in Private Practice 4183070451 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
California Luna Care Physical Therapy PCGroup PAC ID 9638427834, 769 clinicians
Prosport Physical Therapy Professionals IncGroup PAC ID 0749510634, 93 clinicians

Practice addresses (Care Compare)

16185 Los Gatos Blvd
Suite 205
Los Gatos, CA 95032-4569
Phone (866) 525-3175

2777 Bristol St
Suite B
Costa Mesa, CA 92626-5997
Phone (949) 250-1112

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
304632CAMDOrthopedic Physical Therapist
070.026600ILMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Prosport Physical Therapy Professionals Inc Orthopedic CurrentSince Oct 6, 2023 Accepting new patients
Prosport Physical Therapy Professionals Inc Orthopedic CurrentSince Oct 6, 2023 Accepting new patients
California Luna Care Physical Therapy PC Orthopedic CurrentSince Feb 17, 2025 Accepting new patients

Locations

559 E Carson St
Ste B
Carson, CA 90745
Phone (424) 201-5242

2777 Bristol St
Ste B
Costa Mesa, CA 92626
Phone (949) 250-1112

26672 Portola Pkwy
Ste 116
Foothill Rnch, CA 92610
Phone (714) 450-4999

16185 Los Gatos Blvd
Ste 205
Los Gatos, CA 95032
Phone (408) 459-8108

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1688947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714521600000",
    "number": "1174201099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2777 BRISTOL ST STE B",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926265997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2777 BRISTOL ST STE B",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926265997",
            "telephone_number": "949-250-1112"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5700 S Cicero Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606383831",
            "country_code": "US",
            "telephone_number": "630-856-8682",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CRAVER",
        "first_name": "CAMERON",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-10",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CA",
            "license": "304632",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "IL",
            "license": "070.026600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Costa Mesa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.