BACK BAY MEDICAL LLC (NPI# 1073528469) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073528469 |
| Entity Type | Organization |
| Organization Name | BACK BAY MEDICAL LLC |
| Other Organization Name | ADVANCED BODY SCAN OF NEWPORT |
| Practice Address |
20311 Sw Acacia St Suite 140 Newport Beach CA 92660-1733 |
| Practice Telephone | 9497568200 |
| Practice Fax Number | 9492038542 |
| Mailing Telephone | 9497568200 |
| Mailing Fax Number | 9492038542 |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2007-10-22 |
| Authorized Official Name | DR. GREGORY A ROBERTSON (DIRECTOR) |
| Authorized Official Telephone | 9497568200 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0200X |
Clinic/Center Specialization: Radiology |
TG158 | CA | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Advanced Body Scan of Newport | Doing Business As Name - Organization |
| Street Address |
20311 SW ACACIA ST SUITE 140 |
| City | NEWPORT BEACH |
| State | CA |
| Zip Code | 92660-1733 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669472148 | Jeffrey Howard Bloom | Family Medicine | 20311 Sw Acacia St, Suite 100, Newport Beach, CA 92660-1733 | 2005-07-27 |
| 1538405220 | Jeffrey Bloom D.o. Inc, Dba Back Bay Medical | Family Medicine | 20311 Sw Acacia St, #100, Newport Beach, CA 92660-1733 | 2012-12-27 |
| 1417197443 | Gregory A Robertson Md A Professional Medical Corporation | Internal Medicine | 20311 Sw Acacia St, Ste 100, Newport Beach, CA 92660-1733 | 2009-03-04 |
| 1932281011 | Gregory A Robertson | Internal Medicine | 20311 Sw Acacia St, Ste 100, Newport Beach, CA 92660-1733 | 2006-10-19 |
| 1487609939 | Russell S. Alterman | Internal Medicine | 20311 Sw Acacia St, Suite 100, Newport Beach, CA 92660-1733 | 2006-05-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275144024 | Lumins Aesthetic and Wellness, Inc | Dermatology | 20281 Sw Birch St, Suite 201, Newport Beach, CA 92660 | 2020-08-14 |
| 1205445798 | Felecia A Pedrogo | Marriage & Family Therapist | 5020 Campus Street, Newport Beach, CA 92660 | 2020-07-30 |
| 1649898388 | Polyviou Dental Corportation, Inc. | Clinic/Center | 120 Newport Beach Drive, Suite 27, Newport Beach, CA 92660 | 2020-07-09 |
| 1154974525 | Jan M. Eckermann, Md Inc. | Neurological Surgery | 1617 W Cliff Dr, Ste 203, Newport Beach, CA 92660 | 2019-07-24 |
| 1235792219 | Horizon Dermatology and Laser Institute | Dermatology | 369 San Miguel Dr. Suite 200, Newport Beach, CA 92660 | 2019-04-16 |
| 1902366925 | Yasmine Central Gohar | Marriage & Family Therapist | 20271 Sw Birch St Ste 200, Newport Beach, CA 92660 | 2019-03-25 |
| 1245703255 | Charison Counseling | Counselor | 4000 Macarthur Bvd Suite 600 East Tower, Newport Beach, CA 92660 | 2019-01-03 |
| 1134698996 | Amber Werner | Chiropractor | 4029 Westerly Place, Suite #115, Newport Beach, CA 92660 | 2018-11-21 |
| 1861969008 | Healthy Me Oc | Dietitian, Registered | 4569 Macarthur Court, Suite 1100, Newport Beach, CA 92660 | 2018-10-25 |
| 1174015192 | Edwin Enwia | Clinic/Center | 1000 Bristol St N Ste 1b, Newport Beach, CA 92660 | 2018-06-05 |
| Find all providers in zip 92660 | ||||
| Taxonomy Code | 261QR0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Radiology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932117249 | Newport Diagnostic Center Inc | Clinic/Center | 1605 Avocado, Newport Beach, CA 92660 | 2006-08-03 |
| 1891232294 | Back Bay Imaging Inc. | Clinic/Center | 301 Bayview Cir, Suite 105, Newport Beach, CA 92660-2948 | 2017-01-23 |
| 1881097095 | Wave Imaging LLC | Clinic/Center | 280 Newport Center Dr, Suite 100, Newport Beach, CA 92660-7526 | 2014-10-01 |
| 1982037859 | Wave Imaging, LLC | Clinic/Center | 3300 W Coast Hwy, Suite B, Newport Beach, CA 92663-4026 | 2013-08-15 |
| 1922038165 | Birch Medical Office Center, LLC | Clinic/Center | 20162 Sw Birch St, Suite 150, Newport Beach, CA 92660-0787 | 2006-07-04 |
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| 1538700588 | Central Valley Medical Imaging, LLC | Clinic/Center | 1125 E Spruce Ave Ste 103, Fresno, CA 93720-3385 | 2019-10-01 |
| 1700447497 | Ester A Hanna | Clinic/Center | 72650 Fred Waring Dr Ste 107, Palm Desert, CA 92260-5007 | 2019-06-24 |
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| City | NEWPORT BEACH |
| Zip Code | 92660 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.