NPIMap

Individual provider Active NPI

William L Van Der Reis

  • Specialist
  • San Clemente, CA
National Provider Identifier
1710911078
Registry record updated Apr 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
G81476 Issued in CA
Practice address
653 Camino de Los Mares Ste 109
San Clemente, CA 92673-2808
Phone
(949) 661-2423
Fax
(949) 661-9205
NPI assigned
Jul 10, 2006
Last updated
Apr 22, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X G81476 CA Primary

Addresses

Primary practice location

653 Camino de Los Mares Ste 109
San Clemente, CA 92673-2808

Mailing address

653 Camino de Los Mares Ste 109
San Clemente, CA 92673-2808
Phone (949) 661-2423

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, HI2 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
I20081101000132 CA Practitioner - Orthopedic Surgery 0648277855 Reassigns benefits to 2 organizations
I20220729002190 HI Practitioner - Sports Medicine 0648277855 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Sports Medicine
Education
JS Weill Medical College, Cornell University, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Island Orthopaedics, LLCGroup PAC ID 1850578030, 12 clinicians

Practice addresses (Care Compare)

3382 Waialae Ave
Honolulu, HI 96816-2637
Phone (808) 548-7033

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement1-10
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)21
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G81476CAMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Island Orthopaedics, LLC CurrentSince Sep 1, 2022 Accepting new patients
Island Orthopaedics, LLC CurrentSince Sep 1, 2022 Accepting new patients
Minimally Invasive Medical Group CurrentSince May 1, 2022 Accepting new patients
Integrated Pain Management Medical Group, Inc. CurrentSince May 1, 2017 Accepting new patients
Mission Hospital Regional Medical Center Past Accepting new patients
The Orthopedic Clinic LC Past Accepting new patients
Saddleback Memorial Medical Center Past Accepting new patients
Island Orthopaedics, LLC Past Accepting new patients
Los Alamitos Medical Center, Inc. Past Accepting new patients

Locations

26921 Crown Valley Pkwy
Ste 120
Mission Viejo, CA 92691
Phone (949) 333-2224

450 N Wiget Ln
Walnut Creek, CA 94598
Phone (925) 413-4960

91-2135 Fort Weaver Rd
Fl 4
Ewa Beach, HI 96706
Phone (808) 548-7033

91-2139 Fort Weaver Rd
Ste 305
Ewa Beach, HI 96706
Phone (808) 548-7036

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 10

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.

Hospital & facility affiliations 3

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": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398124800000",
    "number": "1710911078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "653 CAMINO DE LOS MARES STE 109",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926732808",
            "telephone_number": "949-661-2423",
            "fax_number": "949-661-9205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "653 CAMINO DE LOS MARES STE 109",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926732808",
            "telephone_number": "949-661-2423",
            "fax_number": "949-661-9205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DER REIS",
        "first_name": "WILLIAM",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2014-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "G81476",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Clemente, CA

Sources for this page

Verify at the official NPI Registry.