Ma. Olivia Roque San Diego, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036-130487 Issued in IL

Practice address

1044 N Mozart St
Ste 205
Chicago, IL 60622-2792

Phone

(773) 489-2912

Fax

(773) 489-7330

NPI assigned

May 18, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ma. Olivia Santos Roque Other name

Electronic endpoints 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Riverside, CA
  • NPI 1316979834
  Medicare reassignment NPD
• Ma. Olivia R. San Diego, M.D., S.C.

  • Pediatrics Physician
  • Chicago, IL
  • NPI 1245580653
  NPD (past) Authorized official
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Santa Clarita, CA
  • NPI 1316409410
  NPD

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1285842997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1044 N MOZART ST",
            "address_2": "STE 205",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606222792",
            "telephone_number": "773-489-2912",
            "fax_number": "773-489-7330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 N MOZART ST",
            "address_2": "STE 205",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606222792",
            "telephone_number": "773-489-2912",
            "fax_number": "773-489-7330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAN DIEGO",
        "first_name": "MA. OLIVIA",
        "middle_name": "ROQUE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-18",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036-130487",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10800 Magnolia Ave",
            "city": "Riverside",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925053043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MA. OLIVIA",
            "last_name": "ROQUE",
            "middle_name": "SANTOS",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Leokadia Samulak
• Samulio Cvetkovic PLLC
• Alexander Gareth Samworth, M.D.
• Bharathi Samy, M.D.
• Christina Samycia, PSYD
• Aleyda Maria San Hernandez, MD
• April Lei San Juan, DNP, APN, FNP-C
• Lauren San Juan, PHARMD
• Genevieve San Nicolas, APRN, AGACNP-BC, DNP
• San Pablo Medical Center

• Pediatrics Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.