Individual provider Active NPI

Rudy Martin, PT

  • Physical Therapist
  • Buena Park, CA
National Provider Identifier
1639424641
Registry record updated Jul 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
39085 Issued in CA
Practice address
6131 Orangethorpe Ave Ste 135
Buena Park, CA 90620-4901
Phone
(714) 523-3822
NPI assigned
Jul 16, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2012

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 39085 CA Primary

Addresses

Primary practice location

6131 Orangethorpe Ave Ste 135
Buena Park, CA 90620-4901

Mailing address

2311 Elden Ave Apt 24
Costa Mesa, CA 92627-1590
Phone (949) 244-8328

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120821000865 CA Practitioner - Physical Therapist in Private Practice 4284881590 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
John M Somerndike Physical Therapy PCGroup PAC ID 4587832431, 3 clinicians

Practice addresses (Care Compare)

2854 N Santiago Blvd
Suite 100
Orange, CA 92867-1700
Phone (714) 771-7047

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
39085CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
John M. Somerndike Physical Therapy, PC Physical Therapist CurrentSince Jun 1, 2015 Accepting new patients
Sequoia Physical Therapy, Inc CurrentSince Jul 7, 2012 Accepting new patients
Sequoia Physical Therapy Research Institute Inc PastSince Jul 7, 2012 Accepting new patients

Locations

6131 Orangethorpe Ave
Ste 135
Buena Park, CA 90620
Phone (714) 523-3822

6131 Orangethorpe Ave
Ste 180
Buena Park, CA 90620
Phone (714) 523-5030

2854 N Santiago Blvd
Ste 100
Orange, CA 92867
Phone (714) 771-7047

415 N Tustin St
Orange, CA 92867
Phone (714) 744-8244

Organizations & group practices 3

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": "1342396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342396800000",
    "number": "1639424641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2311 ELDEN AVE APT 24",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926271590",
            "telephone_number": "949-244-8328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6131 ORANGETHORPE AVE STE 135",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906204901",
            "telephone_number": "714-523-3822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "RUDY",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-16",
        "last_updated": "2012-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "39085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buena Park, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2012; 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.