NPIMap

Organization Active NPI

Bespoke San Diego Physical Therapy PC

  • Physical Therapy Clinic/Center
  • San Diego, CA
National Provider Identifier
1245847540
Registry record updated Sep 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
BESPOKE SAN DIEGO PHYSICAL THERAPY PC
Practice address
2748 Ariane Dr
Unit 141
San Diego, CA 92117-3407
Phone
(509) 294-5289
Fax
(646) 358-3443
NPI assigned
Sep 30, 2020
Last updated
Sep 30, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2020

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

Authorized official

Name
Matthew Guskin
Title
Director of Billing/Collections
Phone
(646) 596-7427

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

2748 Ariane Dr
Unit 141
San Diego, CA 92117-3407

Mailing address

2748 Ariane Dr
Unit 141
San Diego, CA 92117-3407
Phone (509) 294-5289

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230127000545 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 7012388168 Receives reassigned benefits from 18 practitioners
Practice locations: Del Mar, CA

National Provider Directory

National Provider Directory

Locations

2690 Via de la Valle
Ste D160
Del Mar, CA 92014
Phone (858) 290-0855

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1601424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601424000000",
    "number": "1245847540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2748 ARIANE DR",
            "address_2": "UNIT 141",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921173407",
            "telephone_number": "509-294-5289",
            "fax_number": "646-358-3443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2748 ARIANE DR",
            "address_2": "UNIT 141",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921173407",
            "telephone_number": "509-294-5289",
            "fax_number": "646-358-3443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BESPOKE SAN DIEGO PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-30",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A",
        "authorized_official_last_name": "GUSKIN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "DIRECTOR OF BILLING/COLLECTIONS",
        "authorized_official_telephone_number": "646-596-7427"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 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.