NPIMap

Organization Active NPI

De Anza Orthopedic Medical Group, Inc.

  • Orthopaedic Surgery Physician
  • Moreno Valley, CA
National Provider Identifier
1255762340
Registry record updated Jun 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
DE ANZA ORTHOPEDIC MEDICAL GROUP, INC.
Practice address
26520 Cactus Ave
Moreno Valley, CA 92555
Phone
(951) 486-5690
Fax
(951) 486-5213
NPI assigned
Nov 27, 2013
Last updated
Jun 26, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2018

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

Authorized official

Name
Wade Faerber, DONPI 1700856713
Title
Director
Phone
(951) 486-5690

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
Orthopaedic Surgery Physician 207X00000X NU Primary

Addresses

Primary practice location

26520 Cactus Ave
Moreno Valley, CA 92555

Mailing address

PO Box 7270
Moreno Valley, CA 92552-7270

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160113001801 CA Part B Supplier - Clinic/Group Practice 9739481375 Receives reassigned benefits from 26 practitioners
Practice locations: Moreno Valley, CA
O20240123003145 CA DME Supplier - Physician - Orthopedic/Orthopedic Surgery 9739481375 Practice locations: Moreno Valley, CA

National Provider Directory

National Provider Directory

Locations

26600 Cactus Ave
Fl 2
Moreno Valley, CA 92555

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1385510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529971200000",
    "number": "1255762340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7270",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925527270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26520 CACTUS AVE",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "92555",
            "telephone_number": "951-486-5690",
            "fax_number": "951-486-5213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DE ANZA ORTHOPEDIC MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-27",
        "last_updated": "2018-06-26",
        "status": "A",
        "authorized_official_last_name": "FAERBER",
        "authorized_official_first_name": "WADE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "951-486-5690",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moreno Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 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.