Individual provider Active NPI

Mikhail Roubakha, MD

  • Diagnostic Radiology Physician
  • Los Angeles, CA
National Provider Identifier
1699262683
Registry record updated Apr 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
A176054 Issued in CA
Practice address
757 Westwood PLZ
Los Angeles, CA 90095-2621
Phone
(310) 301-6800
NPI assigned
Apr 16, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 3, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 1013313 MA
Diagnostic Radiology Physician 2085R0202X A176054 CA Primary

Addresses

Primary practice location

757 Westwood PLZ
Los Angeles, CA 90095-2621

Mailing address

5767 W Century Blvd Ste 400
Los Angeles, CA 90045-5631

Other practice location 1

55 Fruit St
Boston, MA 02114-2621
Phone (617) 726-8323

Other practice location 2

836 W Wellington Ave
Chicago, IL 60657-5147
Phone (773) 296-5424

Other names 1

  • Michael Roubakha Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NY2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20240216004318 CA Practitioner - Diagnostic Radiology 3173876828 Reassigns benefits to 1 organization
I20250117000129 NY Practitioner - Diagnostic Radiology 3173876828 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Washington University School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

111 Broadway
New York, NY 10006-1901
Phone (212) 263-9700

1300 Ave P
Brooklyn, NY 11229-1106
Phone (718) 376-1004

13303 Jamaica Ave
Jamaica, NY 11418-2618
Phone (718) 206-6923

135 E 31St St
New York, NY 10016-6812
Phone (646) 754-2400

150 55TH St
Brooklyn, NY 11220-2508
Phone (718) 630-7000

150 E 32ND St
New York, NY 10016-6058
Phone (212) 263-3049

159 E 53Rd St
New York, NY 10022-4602
Phone (646) 754-3300

227 Madison St
New York, NY 10002-7537
Phone (212) 238-7000

2318 31St St
Suite 200
Astoria, NY 11105-2765
Phone (718) 777-7742

462 1St Ave
New York, NY 10016-9196
Phone (212) 263-7300

530 1St Ave
New York, NY 10016-6402
Phone (212) 263-7300

550 1St Ave
New York, NY 10016-6402
Phone (212) 263-7300

560 1St Ave
New York, NY 10016-6402
Phone (212) 263-7300

6915 Austin St
Forest Hills, NY 11375-4255
Phone (718) 544-5100

74 Kent St
Brooklyn, NY 11222-1517
Phone (516) 365-4949

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A176054CAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
New York City Health and Hospitals Corporation CurrentSince Nov 23, 2024 Accepting new patients
Martin Luther King Jr Community Medical Foundation CurrentSince Apr 1, 2024 Accepting new patients
Martin Luther King Jr Community Medical Foundation Current Accepting new patients
New York University CurrentSince Feb 1, 2025 Accepting new patients
Martin Luther King Jr Community Medical Foundation CurrentSince Apr 1, 2024 Accepting new patients
New York University CurrentSince Feb 1, 2025 Accepting new patients
New York City Health and Hospitals Corporation CurrentSince Nov 23, 2024 Accepting new patients
Regents Univ of Calif Los Angeles Past Accepting new patients

Locations

2215 W Rosecrans Ave
Ste 22
Compton, CA 90222
Phone (424) 529-6755

227 Madison St
New York, NY 10002
Phone (212) 238-7000

50 Water St
Fl 3
New York, NY 10004

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722

Interoperability endpoints

  • Direct secure messaging: mroubakha4753926@nychhc.direct-ci.com

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 10

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": "1523836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712102400000",
    "number": "1699262683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD STE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "757 WESTWOOD PLZ",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900952621",
            "telephone_number": "310-301-6800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "55 Fruit St",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021142621",
            "country_code": "US",
            "telephone_number": "617-726-8323",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "836 W Wellington Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606575147",
            "country_code": "US",
            "telephone_number": "773-296-5424",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROUBAKHA",
        "first_name": "MIKHAIL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-16",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MA",
            "license": "1013313",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A176054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHAEL",
            "last_name": "ROUBAKHA",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.