Jesse Tabisula Lamog, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT295254 Issued in CA

Practice address

14682 Central Ave
Chino, CA 91710-9505

Phone

(951) 376-2692

Fax

(951) 684-2980

NPI assigned

Aug 24, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in HI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kaiser Foundation Health Plan IncGroup PAC ID 1850205360, 107 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kaiser Foundation Health Plan Inc

  dba Kaiser Honolulu Clinic Radiology

  • Radiology Clinic/Center
  • Honolulu, HI
  • NPI 1063515567
  Medicare reassignment Care Compare group NPD
• Total Wellness Inc

  dba Marketplace Physical Therapy

  • Physical Therapy Clinic/Center
  • Riverside, CA
  • NPI 1922299338
  NPD
• Kaiser Foundation Health Plan Inc

  dba Kaiser Hilo Clinic Radiology

  • Radiology Clinic/Center
  • Hilo, HI
  • NPI 1386767135
  NPD
• Kaiser Foundation Health Plan Inc

  dba Kaiser Hawaii Kai Clinic Laboratory

  • Clinical Medical Laboratory
  • Honolulu, HI
  • NPI 1851306385
  NPD
• Kaiser Foundation Health Plan, Inc

  dba Kahuku Clinic

  • Rural Health Clinic/Center
  • Kahuku, HI
  • NPI 1245773936
  NPD
• Marketplace Physical Therapy Inc, a Professional Corporation

  • Physical Therapy Clinic/Center
  • Riverside, CA
  • NPI 1285190942

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1535068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632441600000",
    "number": "1902387228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3191 MISSION INN AVE STE B",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925074188",
            "telephone_number": "951-376-2692",
            "fax_number": "951-684-2980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14682 CENTRAL AVE",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917109505",
            "telephone_number": "951-376-2692",
            "fax_number": "951-684-2980"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3191 Mission Inn Ave Ste B",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "925074188",
            "country_code": "US",
            "telephone_number": "951-376-2692",
            "fax_number": "951-684-2980",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAMOG",
        "first_name": "JESSE",
        "middle_name": "TABISULA",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-24",
        "last_updated": "2021-09-24",
        "certification_date": "2021-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT295254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/interconnect-prodhim/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "75 Maui Lani Pkwy",
            "city": "Wailuku",
            "state": "HI",
            "country_code": "US",
            "postal_code": "967932463",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Gary T. Lai, M.D.
• Kristy Lai
• Paul Pao-Chien Lai, D.O.
• James M Lally, D.O.
• Melanie Guadalupe Lambourg, LM, CPM
• Marcelino Dellopac Latina, DO
• Mara Gwynne Latts, PHD
• Teresa Layman, M.S. CCC-SLP
• Le Faith, LTD (Chino Health Therapy Center)
• Le-Asis Optometry, Inc. (Oasis Optometry)

• Physical Therapist in Chino, CA
• Providers in Chino, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.