NPIMap

Organization Active NPI

Prosport Physical Therapy Professionals Inc

  • Specialist
  • Rancho Santa Margarita, CA
National Provider Identifier
1487616546
Registry record updated Dec 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
PROSPORT PHYSICAL THERAPY PROFESSIONALS INC
Practice address
22521 Avenida Empresa Ste 116-117
Rancho Santa Margarita, CA 92688-2044
Phone
(949) 766-8535
Fax
(949) 766-8540
NPI assigned
Apr 4, 2006
Last updated
Dec 6, 2023By the provider in NPPES
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
Bobby Ismail
Title
President
Phone
(209) 353-1988

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

22521 Avenida Empresa Ste 116-117
Rancho Santa Margarita, CA 92688-2044

Mailing address

PO Box 14155
Orange, CA 92863-1555
Phone (949) 766-8535

Other names 1

  • ProSport Physical Therapy Rancho Santa Marg., Inc. Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200304001273 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0749510634 Receives reassigned benefits from 107 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Orange, CA; Torrance, CA; San Juan Capistrano, CA; San Clemente, CA; Rancho Santa Margarita, CA; Rancho Palos Verdes, CA; Mission Viejo, CA; Los Angeles, CA…

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Prosport Physical Therapy Professionals Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

22521 Avenida Empresa
Ste 116117
Rancho Santa Margarita, CA 92688
Phone (949) 766-8535

22032 El Paseo
Ste 210
Rcho Sta Marg, CA 92688
Phone (949) 766-8535

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701820800000",
    "number": "1487616546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14155",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928631555",
            "telephone_number": "949-766-8535",
            "fax_number": "949-766-8540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22521 AVENIDA EMPRESA STE 116-117",
            "city": "RANCHO SANTA MARGARITA",
            "state": "CA",
            "postal_code": "926882044",
            "telephone_number": "949-766-8535",
            "fax_number": "949-766-8540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSPORT PHYSICAL THERAPY PROFESSIONALS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-04",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A",
        "authorized_official_last_name": "ISMAIL",
        "authorized_official_first_name": "BOBBY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-353-1988"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ProSport Physical Therapy Rancho Santa Marg., Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Rancho Santa Margarita, 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.