Southern California Spine and Sport Medical Associates, Inc

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

G53385 Issued in CA

Legal business name

SOUTHERN CALIFORNIA SPINE AND SPORT MEDICAL ASSOCIATES, INC

Practice address

1401 Avocado Ave Ste 709
Newport Beach, CA 92660-8714

Phone

(949) 644-5800

Fax

(949) 999-5813

NPI assigned

Jun 10, 2005

Last updated

Apr 26, 2023By 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

Ms. Delgash Dosky

Title

Coo

Phone

(949) 644-5800

Specialties & licenses 6

Addresses

Other names 1

• RMP, Inc. Former legal business name

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/17238/brand/1/csg/1/fhir/r4

Practitioners 21

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.

• Mohammad A Khan, M.D.

  • Pain Medicine (Anesthesiology) Physician
  • Riverside, CA
  • NPI 1922008143
  Medicare reassignment Care Compare group NPD
• Richard Paicius, M.D.

  • Pain Medicine (Anesthesiology) Physician
  • Newport Beach, CA
  • NPI 1326011388
  Medicare reassignment Care Compare group NPD
• Almira Dukovic, PA-C

  • Physician Assistant
  • Newport Beach, CA
  • NPI 1376884338
  Medicare reassignment Care Compare group
• Renee Fabrizi, PA-C

  • Medical Physician Assistant
  • Newport Beach, CA
  • NPI 1902879216
  Medicare reassignment Care Compare group
• Paul Kim, M.D.

  • Interventional Pain Medicine Physician
  • Aliso Viejo, CA
  • NPI 1144541665
  Medicare reassignment NPD
• Andrew Merritt, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Laguna Hills, CA
  • NPI 1760455174
  Medicare reassignment NPD
• Sasha Daniel Speare, RN

  • Family Nurse Practitioner
  • Mission Viejo, CA
  • NPI 1427431477
  Medicare reassignment NPD
• Steve Rhyan, P.A.

  • Physician Assistant
  • Ladera Ranch, CA
  • NPI 1891020483
  Medicare reassignment
• Carmela Borromeo, PT

  • Physical Therapist
  • Santa Ana, CA
  • NPI 1528265402
  NPD (past)
• Tracy Burrows, MPT, OCS

  • Physical Therapist
  • Irvine, CA
  • NPI 1245204478
  NPD (past)
• Claudio M Carvalho, D.O.

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Costa Mesa, CA
  • NPI 1336110683
  NPD (past)
• Daniel Falchetti, PT, MPT

  • Physical Therapist
  • Tustin, CA
  • NPI 1255304242
  NPD (past)

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

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682467200000",
    "number": "1902800543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 AVOCADO AVE STE 709",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926608714",
            "telephone_number": "949-644-5800",
            "fax_number": "949-999-5813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 AVOCADO AVE STE 709",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926608714",
            "telephone_number": "949-644-5800",
            "fax_number": "949-999-5813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA SPINE AND SPORT MEDICAL ASSOCIATES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-10",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-26",
        "status": "A",
        "authorized_official_last_name": "DOSKY",
        "authorized_official_first_name": "DELGASH",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "949-644-5800",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "CA",
            "license": "G53385",
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "Q34724",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA65976",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RMP, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "RMP, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Pain Medicine (Anesthesiology) Physician in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Pain Medicine (Anesthesiology) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2023; 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.