Individual provider Active NPI

Roberto Ruelas, MD

  • Pediatrics Physician
  • Seattle, WA
National Provider Identifier
1194257386
Registry record updated Jun 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
60759965 Issued in WA
Practice address
4800 Sand Point Way NE
Oc.7.830
Seattle, WA 98105-3901
Phone
(206) 987-2525
NPI assigned
Mar 28, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 60759965 WA Primary

Addresses

Primary practice location

4800 Sand Point Way NE
Oc.7.830
Seattle, WA 98105-3901

Mailing address

4800 Sand Point Way NE
Oc.7.830
Seattle, WA 98105-3901

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
I20210413001551 CA Practitioner - Pediatric Medicine 6002184124 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
60759965WAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centro de Salud de la Comunidad de San Ysidro Inc CurrentSince Jan 6, 2021 Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc. Current Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc. CurrentSince Jan 6, 2021 Accepting new patients
Scripps Health Past Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc. Past Accepting new patients

Locations

1637 Third Ave
Ste B
Chula Vista, CA 91911
Phone (619) 425-1780

1136 D Ave
National City, CA 91950
Phone (619) 336-2300

4050 Beyer Blvd
San Ysidro, CA 92173

4004 Beyer Blvd
San Ysidro, CA 92173
Phone (619) 428-1330

1601 Precision Park Ln
San Ysidro, CA 92173
Phone (619) 205-4585

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: rruelas18797@syhealth.direct-ci.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1490659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496361600000",
    "number": "1194257386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 SAND POINT WAY NE",
            "address_2": "OC.7.830",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981053901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 SAND POINT WAY NE",
            "address_2": "OC.7.830",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981053901",
            "telephone_number": "206-987-2525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUELAS",
        "first_name": "ROBERTO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-28",
        "last_updated": "2017-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "60759965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.