Individual provider Active NPI

Rodolfo Ibarra, MD

  • Internal Medicine Physician
  • Long Beach, CA
National Provider Identifier
1376566323
Registry record updated Oct 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G57516 Issued in CA
Practice address
3816 Woodruff Ave
Suite 204
Long Beach, CA 90808-2147
Phone
(562) 423-0436
Fax
(562) 394-9272
NPI assigned
Jul 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X G57516 CA Primary

Addresses

Primary practice location

3816 Woodruff Ave
Suite 204
Long Beach, CA 90808-2147

Mailing address

3816 Woodruff Ave Ste 204
Long Beach, CA 90808-2145
Phone (562) 423-0436

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
I20100210000500 CA Practitioner - Internal Medicine 5698818870 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of California, Geffen School of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prohealth Partners, a Medical GroupGroup PAC ID 2769388412, 236 clinicians

Practice addresses (Care Compare)

3816 Woodruff Ave
Suite 204
Long Beach, CA 90808-2145
Phone (562) 423-0436

911 E San Antonio Dr
Long Beach, CA 90807-2204

Hospital & facility affiliations

  • Memorialcare Long Beach Medical Center Hospital, Long Beach, CA, CCN 050485
  • St Mary Medical Center Hospital, Long Beach, CA, CCN 050191
  • Uci Health-Orange Hospital, Orange, CA, CCN 050348

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
57516CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Prohealth Partners, a Medical Group Internal Medicine Current Accepting new patients
Careconnectmd Ca PC CurrentSince Jun 24, 2022 Accepting new patients
Prohealth Partners a Medical Group Inc Internal Medicine CurrentSince Apr 17, 2000 Accepting new patients
Prohealth Partners, a Medical Group, Inc. Internal Medicine CurrentSince Apr 17, 2000 Accepting new patients
Dignity Health Past Accepting new patients
Coast Plaza Doctors Hospital Past Accepting new patients
Los Alamitos Medical Center, Inc. Past Accepting new patients
Long Beach Memorial Medical Past Accepting new patients

Locations

3090 Bristol St
Ste 200
Costa Mesa, CA 92626
Phone (714) 992-1182

911 E San Antonio Dr
Ste 1
Long Beach, CA 90807
Phone (562) 423-0436

3816 Woodruff Ave
Ste 204
Long Beach, CA 90808
Phone (562) 423-0436

911 E San Antonio Dr
Ste 6
Long Beach, CA 90807
Phone (562) 423-6441

3801 Katella Ave
Ste 330
Los Alamitos, CA 90720
Phone (562) 594-9546

File 54567
Los Angeles, CA 90074
Phone (310) 491-9060

473 E Carnegie Dr
Ste 200
Sn Bernrdno, CA 92408
Phone (562) 803-4500

473 S Carnegie Dr
Ste 200
Sn Bernrdno, CA 92408
Phone (562) 803-4500

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 and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540857600000",
    "number": "1376566323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3816 WOODRUFF AVE STE 204",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908082145",
            "telephone_number": "562-423-0436",
            "fax_number": "562-394-9272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3816 WOODRUFF AVE",
            "address_2": "SUITE 204",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908082147",
            "telephone_number": "562-423-0436",
            "fax_number": "562-394-9272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBARRA",
        "first_name": "RODOLFO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2018-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G57516",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.