Active NPI
Benjamin Haag
- Physical Therapist
- Los Angeles, CA
National Provider Identifier
1275983983
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 299094
- Practice address
- 6080 Center Dr
6TH Floor Suite # 639
Los Angeles, CA 90045 - Phone
- (888) 859-0145
- NPI assigned
- Jun 14, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 12224 | AZ | |
| Physical Therapist | 225100000X | 299094 | CA | Primary |
Addresses
Primary practice location
6080 Center Dr
6TH Floor Suite # 639
Los Angeles, CA 90045
Mailing address
PO Box 1295
Venice, CA 90294-1295
Phone (888) 859-0145
Other practice location 1
1600 Main St Fl 2
Venice, CA 90291-3626
Phone (888) 859-0145
Other practice location 2
333 E Osborn Rd
Ste 101
Phoenix, AZ 85012-2360
Phone (602) 795-8441
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12224 | AZ | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ideal Rehabilitation LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Durable Medical Equipment & Medical Supplies
- Tucson, AZ
- NPI 1831353614
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1465862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701734400000",
"number": "1275983983",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1295",
"city": "VENICE",
"state": "CA",
"postal_code": "902941295",
"telephone_number": "888-859-0145",
"fax_number": "888-858-1601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6080 CENTER DR",
"address_2": "6TH FLOOR SUITE # 639",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90045",
"telephone_number": "888-859-0145"
}
],
"practiceLocations": [
{
"address_1": "1600 Main St Fl 2",
"address_purpose": "LOCATION",
"city": "Venice",
"state": "CA",
"postal_code": "902913626",
"country_code": "US",
"telephone_number": "888-859-0145",
"fax_number": "888-858-1601",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "333 E Osborn Rd",
"address_2": "Ste 101",
"address_purpose": "LOCATION",
"city": "Phoenix",
"state": "AZ",
"postal_code": "850122360",
"country_code": "US",
"telephone_number": "602-795-8441",
"fax_number": "602-795-8447",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HAAG",
"first_name": "BENJAMIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-06-14",
"last_updated": "2023-12-05",
"certification_date": "2023-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "12224",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "299094",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.