Individual provider Active NPI

Audra Vitkus

  • Occupational Therapist
  • Rancho Palos Verdes, CA
National Provider Identifier
1417829169
Registry record updated Sep 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
3500 Issued in CA
Practice address
5801 Crestridge Rd
Rancho Palos Verdes, CA 90275-4964
Phone
(877) 582-0153
NPI assigned
Sep 22, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 22, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225X00000X 3500 CA Primary

Addresses

Primary practice location

5801 Crestridge Rd
Rancho Palos Verdes, CA 90275-4964

Mailing address

4105 Via Solano
Palos Verdes Estates, CA 90274-1131

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251024001752 CA Practitioner - Occupational Therapist in Private Practice 8527556026 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New Life Physical Therapy Services PCGroup PAC ID 7214207125, 94 clinicians

Practice addresses (Care Compare)

5801 Crestridge Rd
Rancho Palos Verdes, CA 90275-4961
Phone (424) 334-5643

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3500CAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
New Life Physical Therapy Services, PC Single Specialty CurrentSince Sep 9, 2025 Accepting new patients

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": "1758499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758499200000",
    "number": "1417829169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4105 VIA SOLANO",
            "city": "PALOS VERDES ESTATES",
            "state": "CA",
            "postal_code": "902741131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5801 CRESTRIDGE RD",
            "city": "RANCHO PALOS VERDES",
            "state": "CA",
            "postal_code": "902754964",
            "telephone_number": "877-582-0153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VITKUS",
        "first_name": "AUDRA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-09-22",
        "last_updated": "2025-09-22",
        "certification_date": "2025-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": "CA",
            "license": "3500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Palos Verdes, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2025; 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.