Individual provider Active NPI

Ruth Legesse, PA-C

  • Physician Assistant
  • Los Angeles, CA
National Provider Identifier
1902330863
Registry record updated May 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
54229 Issued in CA
Practice address
837 W Imperial Hwy
Los Angeles, CA 90044-4110
Phone
(323) 755-9555
Fax
(323) 755-9545
NPI assigned
Apr 18, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 54229 CA Primary

Addresses

Primary practice location

837 W Imperial Hwy
Los Angeles, CA 90044-4110

Mailing address

837 W Imperial Hwy
Los Angeles, CA 90044-4110
Phone (323) 755-9555

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231103000654 CA Practitioner - Physician Assistant 5395155857 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

13365 W Washington Blvd
Los Angeles, CA 90066-5134
Phone (310) 504-1825

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
54229CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carbon Health Medical Group of California PC CurrentSince Oct 24, 2023 Accepting new patients
Southern California Permanente Medical Group CurrentSince Mar 12, 2024 Accepting new patients
Southern California Permanente Medical Group CurrentSince Mar 12, 2024 Accepting new patients

Locations

7330 El Camino Real
Atascadero, CA 93422
Phone (805) 703-2501

8900 Venice Blvd
Ste 109
Culver City, CA 90232
Phone (310) 295-9029

25825 Vermont Ave
Harbor City, CA 90710
Phone (310) 325-5111

393 E Walnut St
Fl 5
Pasadena, CA 91188
Phone (310) 403-3235

2944 Tapo Canyon Rd
Ste A
Simi Valley, CA 93063
Phone (805) 306-5990

Organizations & group practices 5

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": "1492473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715126400000",
    "number": "1902330863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "837 W IMPERIAL HWY",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900444110",
            "telephone_number": "323-755-9555",
            "fax_number": "323-755-9545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "837 W IMPERIAL HWY",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900444110",
            "telephone_number": "323-755-9555",
            "fax_number": "323-755-9545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEGESSE",
        "first_name": "RUTH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-18",
        "last_updated": "2024-05-08",
        "certification_date": "2020-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "54229",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "25825 Vermont Ave",
            "city": "Harbor City",
            "state": "CA",
            "country_code": "US",
            "postal_code": "907103518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.