Individual provider Active NPI

Rommel Bantog Dijon, DPT

  • Geriatric Physical Therapist
  • Laguna Hills, CA
National Provider Identifier
1942486758
Registry record updated Apr 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Physical TherapistTaxonomy code 2251G0304X
License
PT23752 Issued in CA
Practice address
23232 Peralta Dr
113
Laguna Hills, CA 92653-1443
Phone
(949) 922-2776
NPI assigned
Jan 11, 2008
Last updated
Apr 3, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Physical Therapist 2251G0304X PT23752 CA Primary

Addresses

Primary practice location

23232 Peralta Dr
113
Laguna Hills, CA 92653-1443

Mailing address

17401 La Bonita Way
Cerritos, CA 90703-9037
Phone (562) 484-4329

Other identifiers 1

IdentifierTypeStateIssuer
W18659OtherCAMEDICARE GROUP PTAN

Other names 1

  • Rommel Bantog Dijon Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080320000363 CA Practitioner - Physical Therapist in Private Practice 5597841288 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dy Care Rehabilitation Therapy,IncGroup PAC ID 8123256500, 2 clinicians

Practice addresses (Care Compare)

3030 W Olympic Blvd
Suite 220
Los Angeles, CA 90006-6507
Phone (213) 739-6933

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
23752CAMDPsychologist
PT23752CAMDGeriatric Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Dy Care Rehabilitation Therapy,Inc Geriatrics CurrentSince Jul 1, 2021 Accepting new patients
Healthcare Partners Affiliates Medical Group CurrentSince Dec 31, 2015 Accepting new patients
Healthcare Partners Affiliates Medical Group CurrentSince Dec 31, 2015 Accepting new patients
California Rehab Group Geriatrics Past Accepting new patients
Pacific Therapeutic Services Inc Geriatrics PastSince Jun 2, 2009 Accepting new patients

Locations

824 E Carson St
Ste 104
Carson, CA 90745
Phone (310) 830-9706

2707 W Olympic Blvd
Ste 203
Los Angeles, CA 90006
Phone (213) 739-6933

3030 W Olympic Blvd
Ste 220
Los Angeles, CA 90006
Phone (213) 738-7788

14600 Sherman Way
Ste 300
Van Nuys, CA 91405
Phone (818) 781-7097

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1200009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1238716800000",
    "number": "1942486758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17401 LA BONITA WAY",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907039037",
            "telephone_number": "562-484-4329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23232 PERALTA DR",
            "address_2": "113",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926531443",
            "telephone_number": "949-922-2776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIJON",
        "first_name": "ROMMEL",
        "middle_name": "BANTOG",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-11",
        "last_updated": "2009-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "CA",
            "license": "PT23752",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "W18659",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ROMMEL",
            "last_name": "DIJON",
            "middle_name": "BANTOG",
            "credential": "DPT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Laguna Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.