NPIMap

Individual provider Active NPI

Ewa B Farrelly, M.D.

  • Family Medicine Physician
  • Newport Beach, CA
National Provider Identifier
1922325315
Registry record updated Jul 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A114221 Issued in CA
Practice address
351 Hospital Rd Ste 406
Newport Beach, CA 92663-3506
Phone
(949) 646-7733
Fax
(949) 646-6155
NPI assigned
Apr 26, 2010
Last updated
Jul 1, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 1, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A114221 CA Primary

Addresses

Primary practice location

351 Hospital Rd Ste 406
Newport Beach, CA 92663-3506

Mailing address

351 Hospital Rd Ste 406
Newport Beach, CA 92663-3506
Phone (949) 646-7733

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address formanfamilymedicine2@direct.practicefusion.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120810000439 CA Practitioner - Family Practice 5698921427 Practice locations: Newport Beach, CA

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Southern California Keck School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

360 San Miguel Dr
Suite 706
Newport Beach, CA 92660-5927
Phone (949) 646-7733

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
20.51 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
68.37

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions13
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A114221CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saddleback Memorial Medical Center Past Accepting new patients
Long Beach Memorial Medical Past Accepting new patients
Long Beach Memorial Medical Past Accepting new patients
Orange Coast Memorial Medical Center Past Accepting new patients
Desmond E. McGuire, M. D., Inc. PastSince Jul 5, 2020 Accepting new patients
Dr. Todd Forman, Inc. PastSince Jul 5, 2020 Accepting new patients
Children's Hospital of Orange County Past Accepting new patients

Organizations & group practices 7

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1272240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593561600000",
    "number": "1922325315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "351 HOSPITAL RD STE 406",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926633506",
            "telephone_number": "949-646-7733",
            "fax_number": "949-646-6155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "351 HOSPITAL RD STE 406",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926633506",
            "telephone_number": "949-646-7733",
            "fax_number": "949-646-6155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FARRELLY",
        "first_name": "EWA",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-04-26",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A114221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "formanfamilymedicine2@direct.practicefusion.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "351 Hospital Rd Ste 406",
            "city": "Newport Beach",
            "state": "CA",
            "country_code": "US",
            "postal_code": "926633506",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Newport Beach, CA

Sources for this page

Verify at the official NPI Registry.