Individual provider Active NPI

Gergis Raid Ghobrial, M.D.

  • Surgery Physician
  • Long Beach, CA
National Provider Identifier
1508874603
Registry record updated Feb 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
A533370 Issued in CA
Practice address
2650 Elm Ave
Suite 318
Long Beach, CA 90806-1651
Phone
(562) 426-0147
Fax
(888) 206-5318
NPI assigned
Aug 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X A533370 CA Primary

Addresses

Primary practice location

2650 Elm Ave
Suite 318
Long Beach, CA 90806-1651

Mailing address

541 Green Acre Dr
Fullerton, CA 92835-3603
Phone (562) 426-0147

Other identifiers 1

IdentifierTypeStateIssuer
00A533370MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
53337CAMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
A533370CAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of Los Angeles Past Accepting new patients

Organizations & group practices 1

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": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361491200000",
    "number": "1508874603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 GREEN ACRE DR",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353603",
            "telephone_number": "562-426-0147",
            "fax_number": "888-206-5318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 ELM AVE",
            "address_2": "SUITE 318",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908061651",
            "telephone_number": "562-426-0147",
            "fax_number": "888-206-5318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHOBRIAL",
        "first_name": "GERGIS",
        "middle_name": "RAID",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-04",
        "last_updated": "2013-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A533370",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A533370",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.