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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

JOHANNA BACK MD
NPI 1508626797
Student in an Organized Health Care Education/Training Program in Orange, CA

Active since March 22, 2024PECOS Enrolled
200 S MANCHESTER AVE STE 835, ORANGE, CA 92868(714) 480-2440 Get Directions Write a Review

NPPES record last updated: August 7, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Aug 7, 2026, Jun 21, 2024 (2 updates tracked since 2024).

About Johanna Back Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JOHANNA BACK MD (NPI 1508626797) is an individual student in an organized health care education/training program in Orange, California, licensed in California (A210794) and active in the NPI registry since March 2024. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1508626797
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameJOHANNA BACKCredential: MD
Location Address200 S MANCHESTER AVE STE 835Orange, CA 92868-3213
Mailing Address200 S Manchester Ave Ste 835Orange, CA 92868-3213 · (714) 480-2440
Phone(714) 480-2440
Sole ProprietorNo
Enumeration DateMarch 22, 2024
Last NPPES UpdateAugust 7, 20262 updates tracked since enumeration
NPPES CertifiedAugust 7, 2026
✔ NPI 1508626797 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
License✔ Licensed in CA · A210794
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
200 S MANCHESTER AVE STE 835, Orange, CA 92868
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Johanna Back Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 16

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ALEX FRANCES SOPHIA BURANDAY MD
Family Medicine
200 S MANCHESTER AVE STE 835
ORANGE, CA 92868
Orange County (714) 480-2440
SAMUEL BELL MD
Student in an Organized Health Care Education/Training Program
200 S MANCHESTER AVE STE 835
ORANGE, CA 92868
Orange County (714) 480-2440
KEVIN FLORES MD
Student in an Organized Health Care Education/Training Program
200 S MANCHESTER AVE STE 835
ORANGE, CA 92868
Orange County (714) 480-2440
GRACE HASELL
Student in an Organized Health Care Education/Training Program
200 S MANCHESTER AVE STE 835
ORANGE, CA 92868
Orange County (714) 480-2440
AHMAD SEBAI
Student in an Organized Health Care Education/Training Program
200 S MANCHESTER AVE STE 835
ORANGE, CA 92868
Orange County (714) 480-2440
NORMA GALLARDO MD
Student in an Organized Health Care Education/Training Program
200 S MANCHESTER AVE STE 835
ORANGE, CA 92868
Orange County (714) 456-8265
ANDREW GALLARDO DO
Family Medicine
200 S MANCHESTER AVE STE 835
ORANGE, CA 92868
Orange County (714) 480-2440
KRYSTAL GOPAUL MD
Student in an Organized Health Care Education/Training Program
200 S MANCHESTER AVE STE 835
ORANGE, CA 92868
Orange County (714) 480-2440

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Johanna Back's NPI number?

The NPI number for Johanna Back is 1508626797. It was assigned to this individual provider in the NPPES registry on March 22, 2024.

Where is Johanna Back located?

Johanna Back practices at 200 S Manchester Ave Ste 835, Orange, CA 92868. The listed phone number is (714) 480-2440.

What is Johanna Back's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Johanna Back enrolled in Medicare?

Yes. Johanna Back is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Johanna Back was last updated on August 7, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.