Individual provider Active NPI

Anthony F Bisaccia, P.T.

  • Physical Therapist
  • Irvine, CA
National Provider Identifier
1629089834
Registry record updated Apr 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT 27358 Issued in CA
Practice address
36 Mauchly
Ste a
Irvine, CA 92618-2393
Phone
(949) 727-3315
Fax
(949) 727-3624
NPI assigned
Aug 11, 2006
Last updated
Apr 20, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT 27358 CA Primary

Addresses

Primary practice location

36 Mauchly
Ste a
Irvine, CA 92618-2393

Mailing address

200 Newport Center Dr
Newport Beach, CA 92660-7501
Phone (949) 727-3315

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040329001702 CA Practitioner - Physical Therapist in Private Practice 2264324573 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4950 Barranca Pkwy
Suite 302
Irvine, CA 92604-4631
Phone (949) 346-1486

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
27358CAMDGeneral Practice Dentistry
PT 27358CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
California Rehabilitation & Sports Therapy a California Physical Ther Physical Therapist CurrentSince Aug 11, 2006 Accepting new patients
California Rehabilitation & Sports Therapy a California Physical Ther Physical Therapist Current Accepting new patients
California Rehab & Sports Therapy CurrentSince Aug 11, 2006 Accepting new patients
Shadow Management Services, Inc. Physical Therapist Past Accepting new patients

Locations

505 N Euclid St
Ste 680
Anaheim, CA 92801
Phone (714) 780-0010

1640 Newport Blvd
Ste 260
Costa Mesa, CA 92627
Phone (949) 335-7967

11420 Warner Ave
Ste B
Fountain Valley, CA 92708
Phone (657) 204-2959

36 Mauchly
Ste A
Irvine, CA 92618
Phone (949) 374-3315

4950 Barranca Pkwy
Ste 302
Irvine, CA 92604
Phone (949) 346-1486

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429488000000",
    "number": "1629089834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 NEWPORT CENTER DR",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607501",
            "telephone_number": "949-727-3315",
            "fax_number": "949-727-3624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 MAUCHLY",
            "address_2": "STE A",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926182393",
            "telephone_number": "949-727-3315",
            "fax_number": "949-727-3624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BISACCIA",
        "first_name": "ANTHONY",
        "middle_name": "F",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2015-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT 27358",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Irvine, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2015; 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.