NPIMap

Organization Active NPI

California State University Long Beach

Doing business as PT@TheBeach

  • Physical Therapist
  • Long Beach, CA
National Provider Identifier
1861824518
Registry record updated Apr 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
CALIFORNIA STATE UNIVERSITY LONG BEACH
Doing business as
PT@TheBeach
Practice address
1250 N Bellflower Blvd
Kin-105
Long Beach, CA 90840-0004
Phone
(562) 985-8286
NPI assigned
Aug 5, 2013
Last updated
Apr 9, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
CALIFORNIA STATE UNIVERSITY LONG BEACHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 9, 2015

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

Authorized official

Name
James Buenaventura
Title
Director
Phone
(562) 985-8286

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

1250 N Bellflower Blvd
Kin-105
Long Beach, CA 90840-0004

Mailing address

1250 N Bellflower Blvd
Kin-105
Long Beach, CA 90840-0004
Phone (562) 985-8286

Other names 1

  • PT@TheBeach Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150915001405 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9436466042 Receives reassigned benefits from 7 practitioners
Practice locations: Long Beach, CA

National Provider Directory

National Provider Directory
Tax ID family
State of California2 organizations share this tax ID, including this one
Part of
State of California

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1250 N Bellflower Blvd
Rm 105
Long Beach, CA 90840
Phone (562) 985-8286

Practitioners & affiliated clinicians

Practitioners 8

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": "1375660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428537600000",
    "number": "1861824518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 N BELLFLOWER BLVD",
            "address_2": "KIN-105",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908400004",
            "telephone_number": "562-985-8286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 N BELLFLOWER BLVD",
            "address_2": "KIN-105",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908400004",
            "telephone_number": "562-985-8286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALIFORNIA STATE UNIVERSITY LONG BEACH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CALIFORNIA STATE UNIVERSITY LONG BEACH",
        "enumeration_date": "2013-08-05",
        "last_updated": "2015-04-09",
        "status": "A",
        "authorized_official_last_name": "BUENAVENTURA",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "562-985-8286"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PT@TheBeach",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Long Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2015; 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.