NPIMap

Individual provider Active NPI

Prode P Pascual, M.D

  • Geriatric Medicine (Internal Medicine) Physician
  • Norwalk, CA
National Provider Identifier
1558454595
Registry record updated Jun 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
A30986 Issued in CA
Practice address
13222 Bloomfield Ave
Norwalk, CA 90650-3249
Phone
(562) 508-7123
Fax
(888) 675-3950
NPI assigned
Oct 2, 2006
Last updated
Jun 1, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X A30986 CA Primary

Addresses

Primary practice location

13222 Bloomfield Ave
Norwalk, CA 90650-3249

Mailing address

114 Leland CT E
Murfreesboro, TN 37128-7710
Phone (562) 508-7123

Other identifiers 1

IdentifierTypeStateIssuer
00A309860MedicaidCA

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
I20100423000367 CA Practitioner - Internal MedicinePractitioner - Family Practice 5890822720 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Family Practice
Education
Other, 1973
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Prode P Pascual MD IncGroup PAC ID 8224347232, 2 clinicians

Practice addresses (Care Compare)

12801 Victory Blvd
Unit a
North Hollywood, CA 91606-3012
Phone (617) 905-4835

20430 Starshine Rd
Walnut, CA 91789-3539
Phone (424) 789-4691

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
30986CAMDClinical Psychologist
A30986CAMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Activcare Med Group Inc Current Accepting new patients
Pascual Medical Center Inc CurrentSince Jul 1, 2025 Accepting new patients
Careconnectmd Ca PC CurrentSince Jun 27, 2022 Accepting new patients
Garden of Angels Hospice Inc. PastSince Oct 1, 2021 Accepting new patients

Locations

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

12805 Victory Blvd
North Hollywood, CA 91606
Phone (213) 293-2323

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

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Amare Vista HospiceTorrance, CA, CCN B31662 Hospice Contracted Managing Employee (100%) Aug 1, 2023
Oakwood Healthcare Services Inc.Fountain Valley, CA, CCN B31748 Hospice Contracted Managing Employee
Operational/Managerial Control		 Oct 15, 2025
Oct 15, 2025

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685577600000",
    "number": "1558454595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 LELAND CT E",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "371287710",
            "telephone_number": "562-508-7123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13222 BLOOMFIELD AVE",
            "city": "NORWALK",
            "state": "CA",
            "postal_code": "906503249",
            "telephone_number": "562-508-7123",
            "fax_number": "888-675-3950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PASCUAL",
        "first_name": "PRODE",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2023-06-01",
        "certification_date": "2023-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "A30986",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A309860",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norwalk, CA

Sources for this page

Verify at the official NPI Registry.