Active NPI
Nolan Bagalso
- Physical Therapist
- La Crescenta, CA
National Provider Identifier
1407216062
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 40854
- Practice address
- 3050 Montrose Ave
La Crescenta, CA 91214-3619 - Phone
- (818) 957-0850
- NPI assigned
- Feb 25, 2016
- Sex
- Male
- Sole proprietor
- No
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 | 40854 | CA | Primary |
Addresses
Primary practice location
3050 Montrose Ave
La Crescenta, CA 91214-3619
Mailing address
1921 N Buena Vista St Unit 105
Burbank, CA 91504-3377
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160809001278 | CA | Practitioner - Physical Therapist in Private Practice | 0042504391 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- California Luna Care Physical Therapy PC
Practice addresses (Care Compare)
16185 Los Gatos Blvd
Suite 205
Los Gatos, CA 95032-4569
Phone (866) 525-3175
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40854 | CA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| California Luna Care Physical Therapy PC | Physical Therapist | Current | Accepting new patients |
Locations
16185 Los Gatos Blvd
Ste 205
Los Gatos, CA 95032
Phone (408) 459-8108
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.
-
- Physical Therapist
- Los Gatos, CA
- NPI 1689162166
CA, Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1456358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456358400000",
"number": "1407216062",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1921 N BUENA VISTA ST UNIT 105",
"city": "BURBANK",
"state": "CA",
"postal_code": "915043377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3050 MONTROSE AVE",
"city": "LA CRESCENTA",
"state": "CA",
"postal_code": "912143619",
"telephone_number": "818-957-0850"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAGALSO",
"first_name": "NOLAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-02-25",
"last_updated": "2016-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "40854",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Crescenta, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2016; 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.