NPIMap

Organization Active NPI

Core Performance Physical Therapy, Inc.

  • Orthopedic Physical Therapist
  • Newport Beach, CA
National Provider Identifier
1871878041
Registry record updated Oct 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
25614 Issued in CA
Legal business name
CORE PERFORMANCE PHYSICAL THERAPY, INC.
Practice address
15 Corporate Plaza Dr
Suite 130
Newport Beach, CA 92660-7918
Phone
(213) 925-8413
NPI assigned
Oct 19, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2011

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

Authorized official

Name
Amy Bogart
Title
Credentialing Specialist
Phone
(800) 294-7001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 2251X0800X 25614 CA Primary

Addresses

Primary practice location

15 Corporate Plaza Dr
Suite 130
Newport Beach, CA 92660-7918

Mailing address

11 Alisal CT
Aliso Viejo, CA 92656-1850
Phone (213) 925-8143

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111229000500 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 7810163573 Receives reassigned benefits from 22 practitioners
Practice locations: Irvine, CA; Newport Beach, CA

National Provider Directory

National Provider Directory

Locations

33 Creek Rd
Ste 190
Irvine, CA 92604
Phone (949) 262-3031

1 Venture
Ste 110
Irvine, CA 92618

15 Corporate Plaza Dr
Ste 130
Newport Beach, CA 92660
Phone (949) 759-1840

Practitioners & affiliated clinicians

Practitioners 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1318982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318982400000",
    "number": "1871878041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 ALISAL CT",
            "city": "ALISO VIEJO",
            "state": "CA",
            "postal_code": "926561850",
            "telephone_number": "213-925-8143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 CORPORATE PLAZA DR",
            "address_2": "SUITE 130",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607918",
            "telephone_number": "213-925-8413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORE PERFORMANCE PHYSICAL THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-19",
        "last_updated": "2011-10-19",
        "status": "A",
        "authorized_official_last_name": "BOGART",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "800-294-7001"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CA",
            "license": "25614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2011; 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.