Michael T. Vercillo, M.D., Inc.

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

A85526 Issued in CA

Legal business name

MICHAEL T. VERCILLO, M.D., INC.

Practice address

375 Rolling Oaks Dr
Suite 200
Thousand Oaks, CA 91361-1023

Phone

(805) 497-9481

Fax

(805) 497-3416

NPI assigned

Apr 1, 2010

Last updated

Apr 1, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Michael T Vercillo, M.D.NPI 1376767723

Title

President, Ceo

Phone

(310) 600-0111

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

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.

• Michael T. Vercillo, M.D.

  • Orthopaedic Surgery Physician
  • Thousand Oaks, CA
  • NPI 1376767723
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1270080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270080000000",
    "number": "1871818815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 ROLLING OAKS DR",
            "address_2": "SUITE 200",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913611023",
            "telephone_number": "805-497-9481",
            "fax_number": "805-497-3416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 ROLLING OAKS DR",
            "address_2": "SUITE 200",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913611023",
            "telephone_number": "805-497-9481",
            "fax_number": "805-497-3416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL T. VERCILLO, M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-01",
        "last_updated": "2010-04-01",
        "status": "A",
        "authorized_official_last_name": "VERCILLO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT, CEO",
        "authorized_official_telephone_number": "310-600-0111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "A85526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthopaedic Surgery Physician in Thousand Oaks, CA
• Providers in Thousand Oaks, CA by specialty
• Orthopaedic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2010; 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.