Organization Active NPI

Orange County Retina Medical Group

  • Ophthalmology Physician
  • Santa Ana, CA
National Provider Identifier
1750398863
Registry record updated Sep 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
ORANGE COUNTY RETINA MEDICAL GROUP
Practice address
999 N Tustin Ave Ste 17
Santa Ana, CA 92705-6504
Phone
(714) 972-8432
Fax
(714) 560-8402
NPI assigned
Aug 2, 2006
Last updated
Sep 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2024

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

Authorized official

Name
Amy Trecker
Title
RCM Manager
Phone
(714) 972-8432

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X CA Primary

Addresses

Primary practice location

999 N Tustin Ave Ste 17
Santa Ana, CA 92705-6504

Mailing address

999 N Tustin Ave Ste 17
Santa Ana, CA 92705-6504
Phone (714) 972-8432

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050613000472 CA Part B Supplier - Clinic/Group Practice 1951345883 Receives reassigned benefits from 7 practitioners
Practice locations: Fullerton, CA; Laguna Hills, CA; Newport Beach, CA; San Juan Capistrano, CA; Santa Ana, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2030667Orange County Retina Medical Group999 N Tustin Avenue, Suite 17, Santa Ana, CA 92705Certificate of waiverOct 2, 2027

National Provider Directory

National Provider Directory

Locations

16801 Bellflower Blvd
Bellflower, CA 90706
Phone (562) 867-4220

1440 N Harbor Blvd
Ste 708
Fullerton, CA 92835
Phone (714) 451-0801

333 W Bastanchury Rd
Fullerton, CA 92835
Phone (714) 253-5333

23521 Paseo de Valencia
Ste 309
Laguna Hills, CA 92653
Phone (949) 229-3500

320 Superior Ave
Newport Beach, CA 92663
Phone (949) 645-7870

31451 Rancho Viejo Rd
San Juan Capistrano, CA 92675

31451 Rancho Viejo Rd
Ste 101
San Juan Capo, CA 92675
Phone (714) 581-3618

999 N Tustin Ave
Ste 17
Santa Ana, CA 92705
Phone (714) 550-7474

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725840000000",
    "number": "1750398863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "999 N TUSTIN AVE STE 17",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927056504",
            "telephone_number": "714-972-8432",
            "fax_number": "714-972-8474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "999 N TUSTIN AVE STE 17",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927056504",
            "telephone_number": "714-972-8432",
            "fax_number": "714-560-8402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORANGE COUNTY RETINA MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-02",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A",
        "authorized_official_last_name": "TRECKER",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "RCM MANAGER",
        "authorized_official_telephone_number": "714-972-8432"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Ana, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.