Individual provider Active NPI

Rubimar Rivera Vargas, PA-C

  • Physician Assistant
  • Los Angeles, CA
National Provider Identifier
1285387787
Registry record updated Feb 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA60706 Issued in CA
Practice address
808 W 58TH St
Los Angeles, CA 90037-3632
Phone
(323) 541-1600
NPI assigned
Feb 3, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA60706 CA Primary

Addresses

Primary practice location

808 W 58TH St
Los Angeles, CA 90037-3632

Mailing address

4550 Via Marina Apt 104
Marina del Rey, CA 90292-7243
Phone (787) 624-4494

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220919002791 CA Practitioner - Physician Assistant 2365827805 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. John's Community HealthGroup PAC ID 2961482690, 151 clinicians

Practice addresses (Care Compare)

1060 W Exposition Blvd
Los Angeles, CA 90037-3632
Phone (323) 541-1600

2115 N Wilmington Ave
Compton, CA 90222-2030
Phone (310) 603-1332

5701 S Hoover St
Los Angeles, CA 90037-4045
Phone (323) 541-1411

808 W 58TH St
Los Angeles, CA 90037-3632
Phone (323) 541-1400

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
60706CAMDGeneral Practice Dentistry
PA60706CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St. Johns Community Health CurrentSince Jun 8, 2022 Accepting new patients
St. Johns Community Health CurrentSince Jun 8, 2022 Accepting new patients
Kandu Medical Services East Chartered PastSince Jan 21, 2024 Accepting new patients
St. Johns Community Health Past Accepting new patients

Locations

2115 N Wilmington Ave
Compton, CA 90222
Phone (310) 603-1332

4085 S Vermont Ave
Los Angeles, CA 90037
Phone (323) 541-1631

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 6

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": "1643846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643846400000",
    "number": "1285387787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4550 VIA MARINA APT 104",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902927243",
            "telephone_number": "787-624-4494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 W 58TH ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900373632",
            "telephone_number": "323-541-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIVERA VARGAS",
        "first_name": "RUBIMAR",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-03",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA60706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.