NPIMap

Individual provider Active NPI

Fady Boutros, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Orange, CA
National Provider Identifier
1699125880
Registry record updated May 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
A157668 Issued in CA
Practice address
101 The City Dr S BLDG 53
Orange, CA 92868-3201
Phone
(909) 331-1602
NPI assigned
Jun 17, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X A157668 CA Primary

Addresses

Primary practice location

101 The City Dr S BLDG 53
Orange, CA 92868-3201

Mailing address

12019 Huntley Dr
Rancho Cucamonga, CA 91739-2543
Phone (909) 331-1602

Other practice location 1

500 W Hospital Rd
French Camp, CA 95231-9693
Phone (209) 468-6937

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, CA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200623000783 AZ Practitioner - Physical Medicine and Rehabilitation 2062766728 Reassigns benefits to 1 organization
Practice locations: Yuma, AZ
I20241217002524 CA Practitioner - Physical Medicine and Rehabilitation 2062766728 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integrated Rehabilitation Consultants PCGroup PAC ID 5193250959, 2 clinicians
Integrated Trinity Rehabilitation PLLCGroup PAC ID 0648695536, 3 clinicians

Practice addresses (Care Compare)

15120 Kensington Park Dr
Tustin, CA 92782-1801
Phone (714) 832-9200

18111 Brookburst St
Fountain Valley, CA 92708-6728
Phone (714) 832-9200

901 W 24TH St
Yuma, AZ 85364-6384
Phone (928) 726-5000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Quality
95
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A157668CAMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Integrated Rehabilitation Consultants PC Physical Medicine & Rehabilitation CurrentSince Nov 18, 2024 Accepting new patients
Integrated Trinity Rehabilitation PLLC Physical Medicine & Rehabilitation CurrentSince Jul 14, 2020 Accepting new patients
Life Care Centers of America, Inc. Past Accepting new patients

Locations

901 W 24th St
Yuma, AZ 85364
Phone (928) 314-8812

2450 S 19th Ave
Yuma, AZ 85364
Phone (928) 344-0425

2400 S Avenue A
Yuma, AZ 85364
Phone (928) 336-7100

15120 Kensington Park Dr
Tustin, CA 92782
Phone (714) 832-9200

340 E 1st St
Unit 219
Tustin, CA 92781

Interoperability endpoints

  • Direct secure messaging: fboutros447255@direct.memorialcare.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Life Care Center of YumaYuma, AZ, CCN 035133 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Dec 20, 2023
Mar 6, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1466121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589760000000",
    "number": "1699125880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12019 HUNTLEY DR",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917392543",
            "telephone_number": "909-331-1602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 THE CITY DR S BLDG 53",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683201",
            "telephone_number": "909-331-1602"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 W Hospital Rd",
            "address_purpose": "LOCATION",
            "city": "French Camp",
            "state": "CA",
            "postal_code": "952319693",
            "country_code": "US",
            "telephone_number": "209-468-6937",
            "fax_number": "209-468-7042",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOUTROS",
        "first_name": "FADY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-17",
        "last_updated": "2020-05-18",
        "certification_date": "2020-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "A157668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.