Individual provider Active NPI

Ricardo Puertas, MD

  • Family Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1861573230
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G76685 Issued in CA
Practice address
5427 Whittier Blvd
Los Angeles, CA 90022-4101
Phone
(323) 869-1900
Fax
(323) 869-5362
NPI assigned
Oct 18, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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 G76685 CA Primary

Addresses

Primary practice location

5427 Whittier Blvd
Los Angeles, CA 90022-4101

Mailing address

5427 Whittier Blvd
Los Angeles, CA 90022-4101
Phone (323) 869-1900

Other identifiers 1

IdentifierTypeStateIssuer
G76685OtherCASTAE LICENSE

Other names 1

  • Dr. Ricardo Puertas Professional name

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
I20121005000127 CA Order and Referring Only - Family PracticePractitioner - Family Practice 2163459249

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G76685CAMDFamily Medicine Physician

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1861573230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5427 WHITTIER BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900224101",
            "telephone_number": "323-869-1900",
            "fax_number": "323-869-5362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5427 WHITTIER BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900224101",
            "telephone_number": "323-869-1900",
            "fax_number": "323-869-5362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUERTAS",
        "first_name": "RICARDO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G76685",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STAE LICENSE",
            "identifier": "G76685",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RICARDO",
            "last_name": "PUERTAS",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.