Individual provider Active NPI

Ferdinand A Merioles, PT, MTC

  • Physical Therapist
  • Downey, CA
National Provider Identifier
1720204852
Registry record updated Nov 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT22908 Issued in CA
Practice address
9353 Imperial Hwy
PM&R Garden Medical Office ( 3Rd Floor )
Downey, CA 90242-2812
Phone
(562) 657-4803
NPI assigned
Apr 17, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2021

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 PT22908 CA Primary

Addresses

Primary practice location

9353 Imperial Hwy
PM&R Garden Medical Office ( 3Rd Floor )
Downey, CA 90242-2812

Mailing address

9353 Imperial Hwy
PM&R Garden Medical Office ( 3Rd Floor )
Downey, CA 90242-2812
Phone (562) 657-4803

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040917001159 CA Practitioner - Physical Therapist in Private Practice 3678541638 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
22908CAMDMarriage & Family Therapist
PT22908CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Jan 26, 2010 Accepting new patients
Southern California Permanente Medical Group CurrentSince Jan 26, 2010 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients

Locations

9333 Rosecrans Ave
Bellflower, CA 90706
Phone (562) 461-3340

9353 Imperial Hwy
Ofc 3RD
Downey, CA 90242
Phone (562) 657-2428

9333 Imperial Hwy
Downey, CA 90242
Phone (562) 657-8850

9353 Imperial Hwy
Downey, CA 90242
Phone (562) 657-4110

393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914

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": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638144000000",
    "number": "1720204852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9353 IMPERIAL HWY",
            "address_2": "PM&R GARDEN MEDICAL OFFICE ( 3RD FLOOR )",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902422812",
            "telephone_number": "562-657-4803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9353 IMPERIAL HWY",
            "address_2": "PM&R GARDEN MEDICAL OFFICE ( 3RD FLOOR )",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902422812",
            "telephone_number": "562-657-4803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERIOLES",
        "first_name": "FERDINAND",
        "middle_name": "A",
        "credential": "PT, MTC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-17",
        "last_updated": "2021-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT22908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9333 Imperial Hwy",
            "city": "Downey",
            "state": "CA",
            "country_code": "US",
            "postal_code": "902422812",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Downey, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.