NPIMap

Organization Active NPI

Irvine Physical Medicine & Rehabilitation a Medical Corporation

  • Orthopedic Chiropractor
  • Irvine, CA
National Provider Identifier
1366436396
Registry record updated May 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic ChiropractorTaxonomy code 111NX0800X
License
DC24241 Issued in CA
Legal business name
IRVINE PHYSICAL MEDICINE & REHABILITATION A MEDICAL CORPORATION
Practice address
18124 Culver Dr
Suite F
Irvine, CA 92612-2729
Phone
(949) 552-9393
Fax
(949) 552-5872
NPI assigned
Sep 6, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2015

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

Authorized official

Name
Miss Daizy Gutierrez
Title
Billing Manager
Phone
(949) 552-9393

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NX0800X DC24241 CA Primary

Addresses

Primary practice location

18124 Culver Dr
Suite F
Irvine, CA 92612-2729

Mailing address

18124 Culver Dr
Suite F
Irvine, CA 92612-2729
Phone (949) 552-9393

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031204000971 CA Part B Supplier - Clinic/Group Practice 8921903642 Receives reassigned benefits from 4 practitioners
Practice locations: Cypress, CA; Irvine, CA
O20160226000137 CA DME Supplier - Physician - Physical and Rehabilitation 8921903642 Practice locations: Irvine, CA

National Provider Directory

National Provider Directory
Tax ID family
Irvine Physical Medicine Rehab2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431475200000",
    "number": "1366436396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18124 CULVER DR",
            "address_2": "SUITE F",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926122729",
            "telephone_number": "949-552-9393",
            "fax_number": "949-552-5872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18124 CULVER DR",
            "address_2": "SUITE F",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926122729",
            "telephone_number": "949-552-9393",
            "fax_number": "949-552-5872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRVINE PHYSICAL MEDICINE & REHABILITATION A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-06",
        "last_updated": "2015-05-13",
        "status": "A",
        "authorized_official_last_name": "GUTIERREZ",
        "authorized_official_first_name": "DAIZY",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "949-552-9393",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "111NX0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Orthopedic",
            "state": "CA",
            "license": "DC24241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Irvine, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2015; 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.