REGENERATIVE MEDICAL GROUP (NPI# 1881104222) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881104222 |
| Entity Type | Organization |
| Organization Name | REGENERATIVE MEDICAL GROUP |
| Other Organization Name | RMG GARDEN GROVE |
| Practice Address |
12620 Brookhurst St Ste 2 Garden Grove CA 92840 |
| Mailing Address |
615 E Chapman Ave Orange CA 92866-1643 |
| Practice Telephone | 6572510453 |
| Practice Fax Number | 6572510783 |
| Mailing Telephone | 7146394012 |
| Mailing Fax Number | 7146394018 |
| Enumeration Date | 2017-10-11 |
| Last Update Date | 2018-08-28 |
| Authorized Official Name | DR. BRYN JARALD HENDERSON (OWNER) |
| Authorized Official Telephone | 7146394012 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| RMG Garden Grove | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578928867 | Regenerative Medical Group | Family Medicine | 1400 Se Goldtree Dr, Ste 207, Port Saint Lucie, FL 34952-7582 | 2015-12-31 |
| Street Address |
12620 BROOKHURST ST STE 2 |
| City | GARDEN GROVE |
| State | CA |
| Zip Code | 92840 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467533356 | Richard Michael Rutledge | Family Medicine | 12620 Brookhurst St Ste 2, Garden Grove, CA 92840 | 2006-10-18 |
| 1679083026 | Telehealth Medical Group Inc | Family Medicine | 12620 Brookhurst St Ste 2, Garden Grove, CA 92840 | 2017-10-11 |
| 1194002287 | Levo Medical | Durable Medical Equipment & Medical Supplies | 12620 Brookhurst St Ste 2, Garden Grove, CA 92840-4875 | 2011-11-03 |
| 1982858965 | Stanton S Kremsky Md Inc | Clinic/Center | 12620 Brookhurst St Ste 2, Garden Grove, CA 92840-4875 | 2008-11-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588283808 | Kimberly Gaeta | Behavioral Analyst | 123935 Lewis Street, Ste 202, Garden Grove, CA 92840 | 2020-04-16 |
| 1396397170 | Rosa Cortez | Behavior Technician | 12443 Lewis Street, #201, Garden Grove, CA 92840 | 2019-07-12 |
| 1376005934 | Sekboppa Sor | Nurse Practitioner | An Lanh Free Clinic, 10861 Acacia Pkwy., Garden Grove, CA 92840 | 2019-04-03 |
| 1346730116 | Vinh Le Tran | Pharmacist | 12666 Brookhurst St. Suite 110, Garden Grove, CA 92840 | 2018-05-16 |
| 1841715232 | Scott R. Blair | Physician Assistant | 12828 Harbor Blvd Ste 200, Garden Grove, CA 92840 | 2017-08-07 |
| 1881049492 | Carmen Keally | Dietitian, Registered | 12602 9th St, Garden Grove, CA 92840 | 2016-05-02 |
| 1548688732 | House Call Medical Associates, Inc. | Internal Medicine | 12865 Main St Ste 105, Garden Grove, CA 92840 | 2014-04-03 |
| 1851733059 | Carly Ann Wade | Marriage & Family Therapist | 12755 Brookhurst St. Ste 116, Garden Grove, CA 92840 | 2013-07-29 |
| 1003159864 | Priyal Shah Ohri | Dentist | 10602 Chapman Ave, Suite 200, Garden Grove, CA 92840 | 2013-03-30 |
| 1770853244 | Joseph Pham | Pharmacist | 12001 Euclid St., Garden Grove, CA 92840 | 2011-12-30 |
| Find all providers in zip 92840 | ||||
| Taxonomy Code | 207QG0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Geriatric Medicine |
| A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://wwwtheabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932161189 | William Loi Ngo | Family Medicine | 8342 Garden Grove Blvd Ste 5, Garden Grove, CA 92844-1192 | 2006-04-04 |
| 1518930197 | Phuc Thoai Lam | Family Medicine | 10872 Westminster Ave, Suite 114, Garden Grove, CA 92843-4981 | 2006-02-13 |
| 1023652914 | Grace Geriatric Care Inc | Family Medicine | 8883 Westminster Ave, Garden Grove, CA 92844-2608 | 2019-11-04 |
| 1679083026 | Telehealth Medical Group Inc | Family Medicine | 12620 Brookhurst St Ste 2, Garden Grove, CA 92840 | 2017-10-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013516996 | Natasha Harmis | Family Medicine | 1608 Lawndale Rd, El Cajon, CA 92019-3776 | 2020-10-21 |
| 1073135406 | California Gerontology Clinic | Family Medicine | 1042 S Kingsley Dr Ste 3, Los Angeles, CA 90006-2408 | 2020-05-07 |
| 1225657331 | Samantha Lillian Escalera | Family Medicine | 9608 Planter St, Pico Rivera, CA 90660-4743 | 2020-04-09 |
| 1164058897 | Amani A Osman | Family Medicine | 9753 Holder St, Cypress, CA 90630-4004 | 2020-03-13 |
| 1396378980 | David F Shirley M D P C | Family Medicine | 4001 Impala Circle, Roseville, CA 95678 | 2020-02-21 |
| 1013549914 | Vertini Medical Group Inc | Family Medicine | 1001 W Carson St Ste S, Torrance, CA 90502-2051 | 2020-02-07 |
| 1295297463 | Cedars Family Medicine Inc | Family Medicine | 18021 Sky Park Cir Ste G, Irvine, CA 92614-6569 | 2019-04-04 |
| 1811455967 | Hope Geriatric Medical Center Inc | Family Medicine | 9 Coursan, Laguna Niguel, CA 92677-8902 | 2019-03-07 |
| 1245702174 | Jonah Medical Group Inc | Family Medicine | 20627 Golden Springs Dr Ste D, Walnut, CA 91789-4814 | 2018-12-17 |
| 1104392885 | Wilshire Connected Care | Family Medicine | 277 South St Ste S, San Luis Obispo, CA 93401-5039 | 2018-10-19 |
| Find all providers with the same taxonomy | ||||
| City | GARDEN GROVE |
| Zip Code | 92840 |
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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.