Individual provider Active NPI

Raul Ruelas, PA

  • Physician Assistant
  • Covina, CA
National Provider Identifier
1619931128
Registry record updated Apr 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA15586 Issued in CA
Practice address
420 W Rowland St
Covina, CA 91723-2943
Phone
(626) 331-6411
Fax
(626) 251-1560
NPI assigned
Apr 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2008

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 PA15586 CA Primary

Addresses

Primary practice location

420 W Rowland St
Covina, CA 91723-2943

Mailing address

420 W Rowland St
Covina, CA 91723-2943
Phone (626) 331-6411

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
I20040428000916 CA Practitioner - Physician Assistant 3577550839 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA15586CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Emergency Physicians of California Medical Group PC Physician Assistant Past Accepting new patients
Rainbow Basin Emergency Physicians, a Medical Corporation Physician Assistant Past Accepting new patients

Organizations & group practices 3

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": "1144800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209340800000",
    "number": "1619931128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 W ROWLAND ST",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917232943",
            "telephone_number": "626-331-6411",
            "fax_number": "626-251-1560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 W ROWLAND ST",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917232943",
            "telephone_number": "626-331-6411",
            "fax_number": "626-251-1560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUELAS",
        "first_name": "RAUL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-12",
        "last_updated": "2008-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA15586",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Covina, CA

Sources for this page

Verify at the official NPI Registry.