Individual provider Active NPI

Jordan Cruz Rivera, MD,MPH

  • Psychiatry Physician
  • Los Angeles, CA
National Provider Identifier
1821572249
Registry record updated Oct 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A166171 Issued in CA
Practice address
1433 S Robertson Blvd
Los Angeles, CA 90035-3414
Phone
(310) 785-2121
NPI assigned
Sep 21, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Psychiatry Physician 2084P0800X A166171 CA Primary

Addresses

Primary practice location

1433 S Robertson Blvd
Los Angeles, CA 90035-3414

Mailing address

823 Gateway Center Way
San Diego, CA 92102-4541
Phone (619) 515-2300

Other practice location 1

1400 S Grand Ave
Los Angeles, CA 90015-3048
Phone (213) 744-0801

Other practice location 2

3705 Mission Blvd
San Diego, CA 92109-7104
Phone (619) 515-2444

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
I20220513002233 CA Practitioner - Psychiatry 1153714274 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3705 Mission Blvd
San Diego, CA 92109-7104
Phone (619) 515-2444

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A166171CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Centers of San Diego, Inc Current Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Sep 26, 2022 Accepting new patients
Family Health Centers of San Diego, Inc. CurrentSince Sep 26, 2022 Accepting new patients

Locations

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

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": "1537488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664841600000",
    "number": "1821572249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 GATEWAY CENTER WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921024541",
            "telephone_number": "619-515-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1433 S ROBERTSON BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900353414",
            "telephone_number": "310-785-2121"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 S Grand Ave",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900153048",
            "country_code": "US",
            "telephone_number": "213-744-0801",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3705 Mission Blvd",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921097104",
            "country_code": "US",
            "telephone_number": "619-515-2444",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RIVERA",
        "first_name": "JORDAN",
        "middle_name": "CRUZ",
        "name_prefix": "Dr.",
        "credential": "MD,MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-21",
        "last_updated": "2022-10-04",
        "certification_date": "2022-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A166171",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.