Integrated Rehabilitation Consultants PC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

INTEGRATED REHABILITATION CONSULTANTS PC

Practice address

15120 Kensington Park Dr
Tustin, CA 92782-1801

Phone

(714) 832-9200

NPI assigned

Nov 15, 2024

Organization subpart

No

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

Authorized official

Name

Fady BoutrosNPI 1699125880

Title

M.D

Phone

(909) 331-1602

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Fady Boutros, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Orange, CA
  • NPI 1699125880
  Medicare reassignment Care Compare group NPD Authorized official
• Alicia Ryan Chang, NP

  • Family Nurse Practitioner
  • Georgetown, TX
  • NPI 1376245100

  CA

  Medicare reassignment Care Compare group NPD
• Jennifer Tsoi Keihner, MD

  • Physical Medicine & Rehabilitation Physician
  • Anaheim, CA
  • NPI 1760648240
  Medicare reassignment

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

{
    "created_epoch": "1731628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731628800000",
    "number": "1871318865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 E 1ST ST UNIT 219",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927812211",
            "telephone_number": "909-331-1602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15120 KENSINGTON PARK DR",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927821801",
            "telephone_number": "714-832-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED REHABILITATION CONSULTANTS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-15",
        "last_updated": "2024-11-15",
        "certification_date": "2024-11-15",
        "status": "A",
        "authorized_official_last_name": "BOUTROS",
        "authorized_official_first_name": "FADY",
        "authorized_official_title_or_position": "M.D",
        "authorized_official_telephone_number": "909-331-1602"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Medicine & Rehabilitation Physician in Tustin, CA
• Providers in Tustin, CA by specialty
• Physical Medicine & Rehabilitation Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2024; 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.