Michael Port, M.D.

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

License

G77719 Issued in CA

Practice address

13160 Mindanao Way
Suite #300
Marina del Rey, CA 90292-6358

Phone

(310) 854-3800

Fax

(310) 854-3820

NPI assigned

Mar 27, 2007

Last updated

Sep 11, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 1, 2020 through Jul 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Commons Clinic Medical Network, PC

  • Multi-Specialty Clinic/Center
  • Marina del Rey, CA
  • NPI 1952068777
  NPD (past)
• Newport Harbor Anesthesia Consultants Medical Group Inc

  • Anesthesiology Physician
  • Newport Beach, CA
  • NPI 1205885357
  NPD (past)
• Trias Global, LLC

  • Orthopaedic Surgery of the Spine Physician
  • Newport Beach, CA
  • NPI 1518433457
  NPD (past)
• Uscan Anesthesiology Medical Group, Inc.

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Los Angeles, CA
  • NPI 1740227123

  Anesthesiology

  NPD (past)

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1710005731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 EUCALYPTUS DR",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902453839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13160 MINDANAO WAY",
            "address_2": "SUITE #300",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926358",
            "telephone_number": "310-854-3800",
            "fax_number": "310-854-3820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORT",
        "first_name": "MICHAEL",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-27",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "G77719",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "CA",
            "license": "G77719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Xavier Lamance Phillips
• Physiotherapy Associates, Inc (Select Physical Therapy)
• Physiotherapy Associates, Inc.
• Laura K Pietrzak, PA-C
• Leila Pope
• Prairie Medical Group
• Prostate Oncology Specialists, Inc.
• Nadezhda Protasovitskaya, NP
• Carlos Alberto Protzel, LCSW, PSYD
• Providence Healthcare Inc

• Pain Medicine Physician in Marina del Rey, CA
• Providers in Marina del Rey, CA by specialty
• Pain Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.