MEDICARE: NEWPORT CARE MEDICAL GROUP, 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	207XS0117X	Orthopaedic Surgery of the Spine Physician	A92732	CA
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	A97592	CA
3	208100000X	Physical Medicine & Rehabilitation Physician	A106704	CA
4	225100000X	Physical Therapist		CA
5	111NR0400X	Rehabilitation Chiropractor
6	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1528401783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEWPORT CARE MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	441 OLD NEWPORT BLVD
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4233
Country	:	US
Telephone Number	:	949-491-9991
Fax Number	:	949-612-9795

Provider Business Practice Location Address
First Line	:	441 OLD NEWPORT BLVD
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4233
Country	:	US
Telephone Number	:	949-491-9991
Fax Number	:	949-612-9795

Authorized Official
Title or Position	:	SPINE SURGEON, OWNER
Name	:	KASRA ROWSHAN
Credential	:	M.D.
Telephone Number	:	949-491-9991

Provider Enumeration Date	:	04/08/2013
Last Update Date	:	11/06/2024

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