Individual provider Active NPI

Angela Tambunting Echiverri, M.D., M.P.H.

  • Family Medicine Physician
  • Santa Monica, CA
National Provider Identifier
1124376363
Registry record updated Mar 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A129632 Issued in CA
Practice address
2509 Pico Blvd
Santa Monica, CA 90405-1828
Phone
(310) 392-8636
Fax
(310) 943-3521
NPI assigned
Aug 20, 2012
Last updated
Mar 11, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 11, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A129632 CA Primary

Addresses

Primary practice location

2509 Pico Blvd
Santa Monica, CA 90405-1828

Mailing address

2509 Pico Blvd
Santa Monica, CA 90405-1828
Phone (310) 392-8636

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address angela.echiverri.p1@direct.venicefamilyclinic.nextgenshare.com Health Information Exchange (HIE)

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
I20250324000158 CA Practitioner - Family Practice 9234439241 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Venice Family ClinicGroup PAC ID 2264339126, 101 clinicians

Practice addresses (Care Compare)

2509 Pico Blvd
Santa Monica, CA 90405-1828
Phone (310) 664-7901

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A129632CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Venice Family Clinic Current Accepting new patients
Venice Family Clinic Current Accepting new patients
Venice Family Clinic CurrentSince Mar 10, 2025 Accepting new patients
Venice Family Clinic Current Accepting new patients
Venice Family Clinic CurrentSince Mar 10, 2025 Accepting new patients

Locations

4700 Inglewood Blvd
Ste 102
Los Angeles, CA 90230
Phone (310) 664-7901

2509 Pico Blvd
Santa Monica, CA 90405
Phone (310) 664-7901

604 Rose Ave
Venice, CA 90291
Phone (310) 392-8630

905 Venice Blvd
Venice, CA 90291
Phone (310) 392-8630

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: aechiverri792318@direct.ochin.org
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1345420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741651200000",
    "number": "1124376363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2509 PICO BLVD",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904051828",
            "telephone_number": "310-392-8636",
            "fax_number": "310-943-3521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2509 PICO BLVD",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904051828",
            "telephone_number": "310-392-8636",
            "fax_number": "310-943-3521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ECHIVERRI",
        "first_name": "ANGELA",
        "middle_name": "TAMBUNTING",
        "name_prefix": "Dr.",
        "credential": "M.D., M.P.H.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-20",
        "last_updated": "2025-03-11",
        "certification_date": "2025-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A129632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "angela.echiverri.p1@direct.venicefamilyclinic.nextgenshare.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2509 Pico Blvd",
            "city": "Santa Monica",
            "state": "CA",
            "country_code": "US",
            "postal_code": "904051828",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

Verify at the official NPI Registry.