NPIMap

Individual provider Active NPI

Ruben Sangalang Casabar, M.D.

  • General Practice Physician
  • Maywood, CA
National Provider Identifier
1104910629
Registry record updated Nov 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
A47793 Issued in CA
Practice address
6021 Atlantic Blvd
Maywood, CA 90270-3118
Phone
(323) 484-9590
Fax
(323) 457-9103
NPI assigned
Oct 2, 2006
Last updated
Nov 10, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 10, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X A47793 CA Primary

Addresses

Primary practice location

6021 Atlantic Blvd
Maywood, CA 90270-3118

Mailing address

6021 Atlantic Blvd
Maywood, CA 90270-3118
Phone (323) 484-9590

Other identifiers 2

IdentifierTypeStateIssuer
00A477930MedicaidCA
05D0697594OtherCACLIA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040427000577 CA Practitioner - General Practice 0042207656 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Behavioral Health Services Inc.Group PAC ID 8729142146, shared by 6 NPIs, 8 clinicians
Ruben S Casabar MD IncGroup PAC ID 9931347960, 2 clinicians

Practice addresses (Care Compare)

2501 W El Segundo Blvd
Hawthorne, CA 90250-3317

6021 Atlantic Blvd
Maywood, CA 90270-3118
Phone (323) 663-6703

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
47793CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
All Home Mobile Services Inc. CurrentSince Oct 27, 2020 Accepting new patients

Locations

14726 Ramona Ave
Ste E4
Chino, CA 91710
Phone (909) 315-8450

4795 Holt Blvd
Ste 205
Montclair, CA 91763
Phone (714) 496-5710

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JDCJCD/Endpoint/JDCJCD

Organizations & group practices 2

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

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668038400000",
    "number": "1104910629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6021 ATLANTIC BLVD",
            "city": "MAYWOOD",
            "state": "CA",
            "postal_code": "902703118",
            "telephone_number": "323-484-9590",
            "fax_number": "323-457-9103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6021 ATLANTIC BLVD",
            "city": "MAYWOOD",
            "state": "CA",
            "postal_code": "902703118",
            "telephone_number": "323-484-9590",
            "fax_number": "323-457-9103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CASABAR",
        "first_name": "RUBEN",
        "middle_name": "SANGALANG",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2022-11-10",
        "certification_date": "2022-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A47793",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A477930",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "05D0697594",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maywood, CA

Sources for this page

Verify at the official NPI Registry.