Individual provider Active NPI

Philip Andrew Radovic, DPM

  • Foot & Ankle Surgery Podiatrist
  • San Clemente, CA
National Provider Identifier
1649234097
Registry record updated May 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
E3515 Issued in CA
Practice address
665 Camino de Los Mares
Suite 304
San Clemente, CA 92673-2859
Phone
(949) 493-8020
Fax
(949) 488-0868
NPI assigned
Apr 13, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 28, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X E3515 CA Primary

Addresses

Primary practice location

665 Camino de Los Mares
Suite 304
San Clemente, CA 92673-2859

Mailing address

665 Camino de Los Mares
Suite 304
San Clemente, CA 92673-2859
Phone (949) 493-8020

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040803000954 CA Practitioner - Podiatry 6608847728 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
California School of Podiatric Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

665 Camino de Los Mares
Suite 304
San Clemente, CA 92673-2841
Phone (949) 493-8020

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
0

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue17
Removal of skin lesions1-10
Removal of nail tissue74
Removal or shaving of skin growth112

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
E3515CAMDFoot & Ankle Surgery Podiatrist
3515CAMDAdult Psychiatric/Mental Health Clinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
California Foot & Ankle Assoc, Inc Foot & Ankle Surgery CurrentSince Aug 3, 2004 Accepting new patients
Mission Hospital Regional Medical Center Past Accepting new patients
Saddleback Memorial Medical Center Past Accepting new patients

Locations

665 Camino de los Mares
Ste 304
San Clemente, CA 92673
Phone (949) 493-8020

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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": "1144886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748390400000",
    "number": "1649234097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "665 CAMINO DE LOS MARES",
            "address_2": "SUITE 304",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926732859",
            "telephone_number": "949-493-8020",
            "fax_number": "949-488-0868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "665 CAMINO DE LOS MARES",
            "address_2": "SUITE 304",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926732859",
            "telephone_number": "949-493-8020",
            "fax_number": "949-488-0868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADOVIC",
        "first_name": "PHILIP",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-13",
        "last_updated": "2025-05-28",
        "certification_date": "2025-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CA",
            "license": "E3515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Clemente, CA

Sources for this page

Verify at the official NPI Registry.