Individual provider Active NPI

Benjamin Haag

  • Physical Therapist
  • Los Angeles, CA
National Provider Identifier
1275983983
Registry record updated Dec 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
299094 Issued in CA
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

Updated by the provider on Dec 5, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

LicenseStateTypeSpecialty
12224AZMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Ideal Rehabilitation LLC PastSince Nov 15, 2016 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.

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.

Verify at the official NPI Registry.