Individual provider Active NPI

Ricardo A Indacochea, MD

  • Pediatrics Physician
  • Chula Vista, CA
National Provider Identifier
1033375563
Registry record updated Oct 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A110199 Issued in CA
Practice address
1400 E Palomar St
Chula Vista, CA 91913-1800
Phone
(858) 499-2600
NPI assigned
Aug 4, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 6, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A110199 CA Primary
Internal Medicine Physician 207R00000X A110199 CA

Addresses

Primary practice location

1400 E Palomar St
Chula Vista, CA 91913-1800

Mailing address

1400 E Palomar St
Chula Vista, CA 91913-1800
Phone (858) 499-2600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120807000290 CA Practitioner - Internal MedicinePractitioner - Pediatric Medicine 4688820657 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A110199CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sharp Rees-Stealy Medical Group, Inc Internal Medicine CurrentSince Jun 29, 2020 Accepting new patients
Sharp Rees-Stealy Medical Group, Inc CurrentSince Jun 29, 2020 Accepting new patients
Sharp Chula Vista Medical Center Past Accepting new patients
Regents of the University of California Past Accepting new patients
Sharp Rees-Stealy Medical Center Past Accepting new patients
Sharp Memorial Hospital Past Accepting new patients
Sharp Coronado Hospital and Healthcare Center Past Accepting new patients
Sharp Memorial Hospital Past Accepting new patients
Grossmont Hospital Corporation Past Accepting new patients

Locations

1400 E Palomar St
Chula Vista, CA 91913
Phone (619) 397-3077

2020 Genesee Ave
San Diego, CA 92123
Phone (619) 268-9500

Interoperability endpoints

  • Direct secure messaging: rindacochea34529@sharphealthcare.direct-ci.com

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1217808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601942400000",
    "number": "1033375563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 E PALOMAR ST",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919131800",
            "telephone_number": "858-499-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 E PALOMAR ST",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919131800",
            "telephone_number": "858-499-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INDACOCHEA",
        "first_name": "RICARDO",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-04",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A110199",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A110199",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chula Vista, CA

Sources for this page

Verify at the official NPI Registry.