NPIMap

Individual provider Active NPI

Derek Marc Dobalian, MD

  • Gastroenterology Physician
  • Long Beach, CA
National Provider Identifier
1235225467
Registry record updated Aug 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
G48996 Issued in CA
Practice address
3816 Woodruff Ave
Ste # 307
Long Beach, CA 90808
Phone
(562) 420-7670
Fax
(562) 429-4064
NPI assigned
Oct 5, 2006
Last updated
Aug 25, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X G48996 CA Primary

Addresses

Primary practice location

3816 Woodruff Ave
Ste # 307
Long Beach, CA 90808

Mailing address

3816 Woodruff Ave
Ste # 307
Long Beach, CA 90808
Phone (562) 420-7670

Other identifiers 1

IdentifierTypeStateIssuer
00G489960MedicaidCA

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
I20120323000099 CA Practitioner - GastroenterologyPractitioner - Internal Medicine 9638339914 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Loma Linda University School of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

3816 Woodruff Ave
Suite 307
Long Beach, CA 90808-2146
Phone (562) 420-7670

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G48996CAMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Derek M Dobalian a Medical Corporation CurrentSince Oct 19, 1987 Accepting new patients
Alta Los Angeles Hospital, Inc Past Accepting new patients
University of California Irvine Past Accepting new patients
Dignity Health Past Accepting new patients
CHLB, LLC Past Accepting new patients
Coast Plaza Doctors Hospital Past Accepting new patients
Cynthia L Miller Dobalian a Medical Corporation Past Accepting new patients
Tri-City Hospital Past Accepting new patients

Locations

3816 Woodruff Ave
Ste 307
Long Beach, CA 90808
Phone (562) 420-7670

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 8

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 2

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": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282694400000",
    "number": "1235225467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3816 WOODRUFF AVE",
            "address_2": "STE # 307",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "90808",
            "telephone_number": "562-420-7670",
            "fax_number": "562-429-4064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3816 WOODRUFF AVE",
            "address_2": "STE # 307",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "90808",
            "telephone_number": "562-420-7670",
            "fax_number": "562-429-4064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOBALIAN",
        "first_name": "DEREK",
        "middle_name": "MARC",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2010-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CA",
            "license": "G48996",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G489960",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.