Individual provider Active NPI

Bonnie Pittaluga, MD

  • Pediatrics Physician
  • Rancho Santa Margarita, CA
National Provider Identifier
1437135019
Registry record updated Jul 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A83989 Issued in CA
Practice address
29472 Avenida de Las Bandera
Rancho Santa Margarita, CA 92688-2651
Phone
(949) 459-9968
Fax
(949) 766-2565
NPI assigned
Dec 15, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A83989 CA Primary

Addresses

Primary practice location

29472 Avenida de Las Bandera
Rancho Santa Margarita, CA 92688-2651

Mailing address

29472 Avenida de Las Bandera
Rancho Santa Margarita, CA 92688-2651
Phone (714) 665-1600

Other identifiers 1

IdentifierTypeStateIssuer
00A839890MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050923000632 CA Practitioner - Pediatric Medicine 0143254631 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A83989CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorialcare Medical Foundation Pediatrics CurrentSince Feb 1, 2011 Accepting new patients
Long Beach Memorial Medical Past Accepting new patients
Long Beach Memorial Medical Past Accepting new patients
Saddleback Memorial Medical Center Past Accepting new patients
Children'S Hospital at Mission Past Accepting new patients
Bristol Park Medical Group, Inc Pediatrics Past Accepting new patients
Mission Hospital Regional Medical Center Past Accepting new patients
Emergency Medicine Specialists of Orange County Past Accepting new patients
Orange Coast Memorial Medical Center Past Accepting new patients
Children'S Hospital of Orange County Past Accepting new patients

Locations

722 Baker St
Costa Mesa, CA 92626
Phone (714) 557-6300

17360 Brookhurst St
Fountain Vly, CA 92708
Phone (657) 241-3592

29472 Avenida de las Bandera
Rcho Sta Marg, CA 92688
Phone (949) 459-9968

2742 Dow Ave
Tustin, CA 92780
Phone (714) 665-1600

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: bpittaluga193079@direct.memorialcare.org

Organizations & group practices 10

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": "1134604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562112000000",
    "number": "1437135019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29472 AVENIDA DE LAS BANDERA",
            "city": "RANCHO SANTA MARGARITA",
            "state": "CA",
            "postal_code": "926882651",
            "telephone_number": "714-665-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29472 AVENIDA DE LAS BANDERA",
            "city": "RANCHO SANTA MARGARITA",
            "state": "CA",
            "postal_code": "926882651",
            "telephone_number": "949-459-9968",
            "fax_number": "949-766-2565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PITTALUGA",
        "first_name": "BONNIE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-15",
        "last_updated": "2019-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A83989",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A839890",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Santa Margarita, CA

Sources for this page

Verify at the official NPI Registry.