NPIMap

Organization Active NPI

Body Dynamix Integrated Sports Medicine, Inc

  • Physical Medicine & Rehabilitation Physician
  • Tarzana, CA
National Provider Identifier
1912386376
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
BODY DYNAMIX INTEGRATED SPORTS MEDICINE, INC
Practice address
18344 Oxnard Street
Unit 104
Tarzana, CA 91356
Phone
(818) 783-4085
Fax
(818) 783-4065
NPI assigned
May 19, 2015
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Erin Daigle
Title
Billing Manager
Phone
(818) 706-9435

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X CA Primary
Rehabilitation Chiropractor 111NR0400X NU

Addresses

Primary practice location

18344 Oxnard Street
Unit 104
Tarzana, CA 91356

Mailing address

18344 Oxnard Street
Unit 104
Tarzana, CA 91356
Phone (818) 783-4085

Other practice location 1

1011 Rancho Conejo Blvd
Thousand Oaks, CA 91320-1718
Phone (844) 472-1476

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200402003762 CA Part B Supplier - Clinic/Group Practice 4688003221 Receives reassigned benefits from 5 practitioners
Practice locations: Thousand Oaks, CA; Woodland Hills, CA

National Provider Directory

National Provider Directory

Locations

18344 Oxnard St
Ste 104
Tarzana, CA 91356
Phone (818) 783-4085

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1431993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1912386376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18344 OXNARD STREET",
            "address_2": "UNIT 104",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "91356",
            "telephone_number": "818-783-4085",
            "fax_number": "818-783-4065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18344 OXNARD STREET",
            "address_2": "UNIT 104",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "91356",
            "telephone_number": "818-783-4085",
            "fax_number": "818-783-4065"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1011 Rancho Conejo Blvd",
            "address_purpose": "LOCATION",
            "city": "Thousand Oaks",
            "state": "CA",
            "postal_code": "913201718",
            "country_code": "US",
            "telephone_number": "844-472-1476",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BODY DYNAMIX INTEGRATED SPORTS MEDICINE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-19",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "DAIGLE",
        "authorized_official_first_name": "ERIN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "818-706-9435"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": null,
            "primary": true
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tarzana, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.