NPIMap

Organization Active NPI

Uci Physical Medicine & Rehabilitation

  • Physical Medicine & Rehabilitation Physician
  • Orange, CA
National Provider Identifier
1417907379
Registry record updated Dec 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
UCI PHYSICAL MEDICINE & REHABILITATION
Practice address
101 The City Dr S
BLDG 10 Room 211
Orange, CA 92868
Phone
(714) 456-8702
Fax
(714) 456-6248
NPI assigned
May 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2023

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

Authorized official

Name
Uci Health Provider Relations
Title
Ups Provider Relations
Phone
(714) 456-8026

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208100000X Primary

Addresses

Primary practice location

101 The City Dr S
BLDG 10 Room 211
Orange, CA 92868

Mailing address

PO Box 31001-2482
Pasadena, CA 91110-2482
Phone (714) 456-8026

Other identifiers 2

IdentifierTypeStateIssuer
ZZZP3014ZOtherCABLUESHIELD PROVIDER NUMBE
ZZZP3014ZMedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070723000885 CA Part B Supplier - Clinic/Group Practice 8921109786 Receives reassigned benefits from 16 practitioners
Practice locations: Orange, CA

National Provider Directory

National Provider Directory

Locations

680 Langsdorf Dr
Fullerton, CA 92831
Phone (714) 871-9264

101 The City Dr S
Bldg 10
Orange, CA 92868
Phone (714) 456-6141

1451 Irvine Blvd
Ste 100
Tustin, CA 92780

1451 Irvine Blvd
Ste 200
Tustin, CA 92780

Practitioners & affiliated clinicians

Practitioners 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701820800000",
    "number": "1417907379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-2482",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911102482",
            "telephone_number": "714-456-8026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 THE CITY DR S",
            "address_2": "BLDG 10 ROOM 211",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "92868",
            "telephone_number": "714-456-8702",
            "fax_number": "714-456-6248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UCI PHYSICAL MEDICINE & REHABILITATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-11",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A",
        "authorized_official_last_name": "PROVIDER RELATIONS",
        "authorized_official_first_name": "UCI HEALTH",
        "authorized_official_title_or_position": "UPS PROVIDER RELATIONS",
        "authorized_official_telephone_number": "714-456-8026"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUESHIELD PROVIDER NUMBE",
            "identifier": "ZZZP3014Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZP3014Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2023; 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.