Individual provider Active NPI

Travis Scott Rose, D.C.

  • Sports Physician Chiropractor
  • San Diego, CA
National Provider Identifier
1386087716
Registry record updated Aug 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
License
32600 Issued in CA
Practice address
2635 Camino del Rio S
San Diego, CA 92108-3726
Phone
(619) 818-4306
Fax
(619) 828-1030
NPI assigned
Apr 16, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 4, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physician Chiropractor 111NS0005X 32600 CA Primary

Addresses

Primary practice location

2635 Camino del Rio S
San Diego, CA 92108-3726

Mailing address

2635 Camino del Rio S
San Diego, CA 92108-3726
Phone (619) 818-4306

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170324001361 CA Practitioner - Chiropractic 1153606660 Reassigns benefits to 1 organization
Practice locations: San Diego, CA

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - West Sunnyvale, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2635 Camino del Rio S
Suite 301
San Diego, CA 92108-3729
Phone (619) 818-4306

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
32600CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Rose Chiropractic Corporation, a Professional Corporation CurrentSince Dec 23, 2020 Accepting new patients

Locations

2635 Camino del Rio S
Ste 200
San Diego, CA 92108
Phone (619) 818-4306

2635 Camino del Rio S
Ste 301
San Diego, CA 92108
Phone (619) 818-4306

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": "1366070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659571200000",
    "number": "1386087716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2635 CAMINO DEL RIO S",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083726",
            "telephone_number": "619-818-4306",
            "fax_number": "619-828-1030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2635 CAMINO DEL RIO S",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083726",
            "telephone_number": "619-818-4306",
            "fax_number": "619-828-1030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "TRAVIS",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-04-16",
        "last_updated": "2022-08-04",
        "certification_date": "2022-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "CA",
            "license": "32600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.