MEDICARE: CALIFORNIA SPORTS AND ORTHOPAEDIC INSTITUTE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RS0010X	Sports Medicine (Internal Medicine) Physician	A67022	CA
2	208100000X	Physical Medicine & Rehabilitation Physician	PT25357	CA
3	208100000X	Physical Medicine & Rehabilitation Physician	PT21053	CA
4	363AS0400X	Surgical Physician Assistant	PA15294	CA
5	207X00000X	Orthopaedic Surgery Physician	A78633	CA
6	207X00000X	Orthopaedic Surgery Physician	G63226	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ64579Z	OTHER	CA	GROUP NUMBER

General Provider Information

NPI Number	:	1841379831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA SPORTS AND ORTHOPAEDIC INSTITUTE INC

Provider Business Mailing Address
First Line	:	2999 REGENT ST
Second Line	:	STE 225
City	:	BERKELEY
State	:	CA
Zip	:	94705-2146
Country	:	US
Telephone Number	:	510-704-7760
Fax Number	:	510-704-7765

Provider Business Practice Location Address
First Line	:	2999 REGENT ST
Second Line	:	STE 225
City	:	BERKELEY
State	:	CA
Zip	:	94705-2146
Country	:	US
Telephone Number	:	510-704-7760
Fax Number	:	510-704-7765

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ROBERT A EPPLEY
Credential	:	MD
Telephone Number	:	510-704-7760

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	02/26/2013

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