Active NPI
Richard Charles Ortiz, PT
- Physical Therapist
- Grand Terrace, CA
National Provider Identifier
1386957413
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 6456
- Practice address
- 22908 Wren St
Grand Terrace, CA 92313-5580 - Phone
- (951) 990-6578
- Fax
- (909) 614-7049
- NPI assigned
- Jul 18, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 6456 | CA | Primary |
Addresses
Primary practice location
22908 Wren St
Grand Terrace, CA 92313-5580
Mailing address
22908 Wren St
Grand Terrace, CA 92313-5580
Phone (951) 990-6578
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101023000267 | CA | Practitioner - Physical Therapist in Private Practice | 9739372616 |
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1972
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
22908 Wren St
Grand Terrace, CA 92313-5580
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6456 | CA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1279411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1297814400000",
"number": "1386957413",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22908 WREN ST",
"city": "GRAND TERRACE",
"state": "CA",
"postal_code": "923135580",
"telephone_number": "951-990-6578",
"fax_number": "909-614-7049"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22908 WREN ST",
"city": "GRAND TERRACE",
"state": "CA",
"postal_code": "923135580",
"telephone_number": "951-990-6578",
"fax_number": "909-614-7049"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ORTIZ",
"first_name": "RICHARD",
"middle_name": "CHARLES",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-07-18",
"last_updated": "2011-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "6456",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Terrace, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2011; 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.