Gastroenterology Diagnostic Center Medical Group, a Professional

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

GASTROENTEROLOGY DIAGNOSTIC CENTER MEDICAL GROUP, A PROFESSIONAL

Practice address

880 S Atlantic Blvd
Suite G 10
Monterey Park, CA 91754-4700

Phone

(626) 872-6261

Fax

(626) 872-1948

NPI assigned

Mar 8, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Fernando Ibarra, MDNPI 1013082726

Title

Authorized Official

Phone

(626) 872-6261

Specialties & licenses 1

Addresses

Other names 1

• Gastroenterology Diagnostic Center Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Gastroenterology Diagnostic Center Medical GroupCCN 05C0001186

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Fernando Ibarra, MD

  • Gastroenterology Physician
  • Monterey Park, CA
  • NPI 1013082726
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579046400000",
    "number": "1013048461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "880 S ATLANTIC BLVD",
            "address_2": "#G 10",
            "city": "MONTEREY PARK",
            "state": "CA",
            "postal_code": "917544700",
            "telephone_number": "626-872-6261",
            "fax_number": "626-872-1948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 S ATLANTIC BLVD",
            "address_2": "SUITE G 10",
            "city": "MONTEREY PARK",
            "state": "CA",
            "postal_code": "917544700",
            "telephone_number": "626-872-6261",
            "fax_number": "626-872-1948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTROENTEROLOGY DIAGNOSTIC CENTER MEDICAL GROUP, A PROFESSIONAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2020-01-15",
        "certification_date": "2020-01-15",
        "status": "A",
        "authorized_official_last_name": "IBARRA",
        "authorized_official_first_name": "FERNANDO",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "626-872-6261",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gastroenterology Diagnostic Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gastroenterology Diagnostic Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Garfield Medical Center
• Garvey Healthy Family Medical Clinic, Inc
• Garvey Medical Center
• Gary a Luu D.D.S. Inc.
• Gary Leeling DDS, Inc.
• Gastroenterology Medical of Los Angeles Inc
• Fernando Gavia, M.D.
• Nani Gelvezon, D.O.
• Gem Medical Group Corporation
• George H. Wang, M.D. OB/GYN Med Corp

• Ambulatory Surgical Clinic/Center in Monterey Park, CA
• Providers in Monterey Park, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.