NPIMap

Individual provider Active NPI

Ronaldo Violeta Roque, M.D.

  • Internal Medicine Physician
  • Long Beach, CA
National Provider Identifier
1932397189
Registry record updated Oct 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A74823 Issued in CA
Practice address
1760 Termino Ave Ste 104
Long Beach, CA 90804-2169
Phone
(562) 494-8512
Fax
(562) 494-8530
NPI assigned
Oct 11, 2007
Last updated
Oct 11, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 11, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A74823 CA Primary

Addresses

Primary practice location

1760 Termino Ave Ste 104
Long Beach, CA 90804-2169

Mailing address

1760 Termino Ave Ste 104
Long Beach, CA 90804-2169
Phone (562) 494-8512

Other identifiers 1

IdentifierTypeStateIssuer
00A748230MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080115000326 CA Practitioner - Internal Medicine 8729998257 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
West Virginia University School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1760 Termino Ave
Suite 104
Long Beach, CA 90804-2169
Phone (562) 494-8512

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A74823CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ron V. Roque, M.D., Inc. Internal Medicine CurrentSince Jul 15, 2002 Accepting new patients
UCSF Health Community Hospitals Past Accepting new patients
University of California Irvine Past Accepting new patients
Dignity Health Past Accepting new patients
Long Beach Memorial Medical Past Accepting new patients
Long Beach Memorial Medical Past Accepting new patients

Locations

1760 Termino Ave
Ste 104
Long Beach, CA 90804
Phone (562) 494-8512

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Astrea Hospice IncStanton, CA, CCN A11699 Hospice Contracted Managing Employee Mar 15, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1192060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192060800000",
    "number": "1932397189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1760 TERMINO AVE STE 104",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908042169",
            "telephone_number": "562-494-8512",
            "fax_number": "562-494-8530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1760 TERMINO AVE STE 104",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908042169",
            "telephone_number": "562-494-8512",
            "fax_number": "562-494-8530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROQUE",
        "first_name": "RONALDO",
        "middle_name": "VIOLETA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-11",
        "last_updated": "2007-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A74823",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A748230",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.