NPIMap

Organization Active NPI

The Sports Clinic Orthopaedic Medical Associates, Inc.

  • Orthopaedic Surgery Physician
  • Laguna Hills, CA
National Provider Identifier
1376603183
Registry record updated Nov 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
G29856 Issued in CA
Legal business name
THE SPORTS CLINIC ORTHOPAEDIC MEDICAL ASSOCIATES, INC.
Practice address
23961 Calle de la Magdalena
Ste 229
Laguna Hills, CA 92653-3616
Phone
(949) 581-7001
Fax
(949) 581-8410
NPI assigned
Dec 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2009

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

Authorized official

Name
Dr. Wesley Merrill Nottage, M.D.NPI 1235182924
Title
President
Phone
(949) 581-7001

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 PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X G29856 CA Primary

Addresses

Primary practice location

23961 Calle de la Magdalena
Ste 229
Laguna Hills, CA 92653-3616

Mailing address

23961 Calle de la Magdalena
Ste 229
Laguna Hills, CA 92653-3616
Phone (949) 581-7001

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ38138ZOtherCABLUE SHIELD GRP #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040324001456 CA Part B Supplier - Clinic/Group Practice 5597656744 Receives reassigned benefits from 2 practitioners
Practice locations: Laguna Hills, CA

National Provider Directory

National Provider Directory

Locations

24012 Calle de la Plata
Ste 320
Laguna Hills, CA 92653

23961 Calle de la Magdalena
Ste 229
Laguna Hills, CA 92653
Phone (949) 439-9322

24012 Calle de la Plata
Ste 32
Laguna Hills, CA 92653

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257465600000",
    "number": "1376603183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23961 CALLE DE LA MAGDALENA",
            "address_2": "STE 229",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926533616",
            "telephone_number": "949-581-7001",
            "fax_number": "949-581-8410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23961 CALLE DE LA MAGDALENA",
            "address_2": "STE 229",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926533616",
            "telephone_number": "949-581-7001",
            "fax_number": "949-581-8410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SPORTS CLINIC ORTHOPAEDIC MEDICAL ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2009-11-06",
        "status": "A",
        "authorized_official_last_name": "NOTTAGE",
        "authorized_official_first_name": "WESLEY",
        "authorized_official_middle_name": "MERRILL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-581-7001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "G29856",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GRP #",
            "identifier": "ZZZ38138Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laguna Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2009; 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.