Individual provider Active NPI

Luis Ramon Samaniego, M.D.

  • Family Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1821055369
Registry record updated Jan 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G49691 Issued in CA
Practice address
5823 York Blvd Ste 1
Los Angeles, CA 90042-2634
Phone
(323) 255-1575
Fax
(323) 254-2158
NPI assigned
Apr 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X G49691 CA Primary

Addresses

Primary practice location

5823 York Blvd Ste 1
Los Angeles, CA 90042-2634

Mailing address

5823 York Blvd Ste 3
Los Angeles, CA 90042-2634
Phone (323) 255-5643

Other identifiers 3

IdentifierTypeStateIssuer
00G496910MedicaidCA
00G496910OtherCABLUE SHIELD
080052216OtherGAMEDICARE RAILROAD

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100928001405 CA Practitioner - Family Practice 0547386419 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
49691CAMDMarriage & Family Therapist
G49691CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Care Specialists Medical Corporation Family Medicine Current Accepting new patients
Family Care Specialists Medical Corporation Family Medicine Past Accepting new patients
FCS - Highland Park Family Medicine Past Accepting new patients

Locations

1701 E Cesar E Chavez Ave
Ste 230
Los Angeles, CA 90033
Phone (323) 226-1100

5823 York Blvd
Ste 3
Los Angeles, CA 90042
Phone (323) 255-5643

5823 York Blvd
Ste 4
Los Angeles, CA 90042

5823 York Blvd
Ste 1
Los Angeles, CA 90042
Phone (323) 255-1575

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

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": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515628800000",
    "number": "1821055369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5823 YORK BLVD STE 3",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900422634",
            "telephone_number": "323-255-5643",
            "fax_number": "323-254-2158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5823 YORK BLVD STE 1",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900422634",
            "telephone_number": "323-255-1575",
            "fax_number": "323-254-2158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMANIEGO",
        "first_name": "LUIS",
        "middle_name": "RAMON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-27",
        "last_updated": "2018-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G49691",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G496910",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00G496910",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "080052216",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.