Macdremma, Inc

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

MACDREMMA, INC

Practice address

67555 E Palm Canyon Dr # 106
Cathedral City, CA 92234-5467

Phone

(760) 459-8101

NPI assigned

Apr 1, 2021

Organization subpart

No

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

Authorized official

Name

Eileen Ahern

Title

Credentialist

Phone

(800) 954-1800

Specialties & licenses 1

Addresses

Other names 1

• anytime fitness Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gautam K Vadlamudi, M.D.

  • Family Medicine Physician
  • Vacaville, CA
  • NPI 1184729212
  Medicare reassignment NPD
• Derrick Wayne Raburn, PT

  • Physical Therapist
  • Bermuda Dunes, CA
  • NPI 1831136308
  NPD (past)

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

{
    "created_epoch": "1617235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646870400000",
    "number": "1306424148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67555 E PALM CANYON DR # 106",
            "city": "CATHEDRAL CITY",
            "state": "CA",
            "postal_code": "922345467",
            "telephone_number": "760-459-8101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67555 E PALM CANYON DR # 106",
            "city": "CATHEDRAL CITY",
            "state": "CA",
            "postal_code": "922345467",
            "telephone_number": "760-459-8101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACDREMMA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-01",
        "last_updated": "2022-03-10",
        "certification_date": "2022-03-10",
        "status": "A",
        "authorized_official_last_name": "AHERN",
        "authorized_official_first_name": "EILEEN",
        "authorized_official_title_or_position": "CREDENTIALIST",
        "authorized_official_telephone_number": "800-954-1800"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "anytime fitness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lotus Kai Wellness Inc.
• Elizabeth Ann Loverso, PA-C
• Erik M. Luansing, PA-C
• Kathleen D Lubanski, NP
• William Shannon Lydick, L.AC.
• Oscar Maldonado, DDS
• Malka Greene Alley Inc.
• Victoria Malkhasyan, M.D.
• Mary Grace Mamasig
• Lee Bella Abuan Mandap, NURSE PRACTITIONER

• Physical Medicine & Rehabilitation Physician in Cathedral City, CA
• Providers in Cathedral City, CA by specialty
• Physical Medicine & Rehabilitation Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2022; 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.