Active NPI
Roger Alan Donovick, MD
- Psychiatry Physician
- Los Angeles, CA
National Provider Identifier
1710902622
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- A64431
- Practice address
- 11301 Wilshire Blvd
691/129
Los Angeles, CA 90073-1003 - Phone
- (310) 478-3711
- NPI assigned
- Jul 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | A64431 | CA | Primary |
Addresses
Primary practice location
11301 Wilshire Blvd
691/129
Los Angeles, CA 90073-1003
Mailing address
File 2939
Los Angeles, CA 90024
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A644310 | Other | CA | MEDI CAL |
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
| License | State | Type | Specialty |
|---|---|---|---|
| A64431 | CA | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of Nebraska, Dept. of Admin. Services | Past | Accepting new patients | |
| State of Nebraska Dept. of Admin. Services | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba 400 State Building
- Intellectual Disabilities Intermediate Care Facility
- Beatrice, NE
- NPI 1962791764
-
dba Solar Cottages
- Intellectual Disabilities Intermediate Care Facility
- Beatrice, NE
- NPI 1629360656
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202256000000",
"number": "1710902622",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "FILE 2939",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90024"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11301 WILSHIRE BLVD",
"address_2": "691/129",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900731003",
"telephone_number": "310-478-3711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DONOVICK",
"first_name": "ROGER",
"middle_name": "ALAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-12",
"last_updated": "2008-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "A64431",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDI CAL",
"identifier": "00A644310",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.