NPIMap

Organization Active NPI

Martin Rocha MD Inc

  • Pediatrics Physician
  • Lake Arrowhead, CA
National Provider Identifier
1942599600
Registry record updated Apr 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
MARTIN ROCHA MD INC
Practice address
251 N Highway 173, Suite 6
Lake Arrowhead, CA 92321-0716
Phone
(909) 336-3670
Fax
(909) 336-3674
NPI assigned
Apr 4, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2011

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

Authorized official

Name
Dr. Martin Rocha Sr., M.D.NPI 1962435586
Title
Owner
Phone
(909) 659-2850

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

251 N Highway 173, Suite 6
Lake Arrowhead, CA 92321-0716

Mailing address

PO Box 716
Cedar Glen, CA 92321-0716
Phone (909) 336-3670

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110524000294 CA Part A Provider - Rural Health Clinic 0345293056 Practice locations: Cedar Glen, CA

Rural health clinic certification: CCN 058958

Legal name
MARTIN ROCHA MD INC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 24, 2011
Last certification
Jun 22, 2016
Ownership / control type
2B
Organization structure
CorporationProprietary
Enrollment address
251N Hwy 173
Suite 6
Cedar Glen, CA 92321-0716

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Martin Rocha MD Inc Organization, Cedar Glen, CA 5% Or Greater Direct Ownership Interest Nov 1, 2004
Patricia Rocha Individual 5% Or Greater Direct Ownership Interest Nov 4, 2004
Operational/Managerial Control Nov 4, 2004
Martin Rocha Individual 5% Or Greater Direct Ownership Interest Nov 4, 2004

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1301875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301875200000",
    "number": "1942599600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 716",
            "city": "CEDAR GLEN",
            "state": "CA",
            "postal_code": "923210716",
            "telephone_number": "909-336-3670",
            "fax_number": "909-336-3674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "251 N HIGHWAY 173, SUITE 6",
            "city": "LAKE ARROWHEAD",
            "state": "CA",
            "postal_code": "923210716",
            "telephone_number": "909-336-3670",
            "fax_number": "909-336-3674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN ROCHA MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-04",
        "last_updated": "2011-04-04",
        "status": "A",
        "authorized_official_last_name": "ROCHA",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-659-2850",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Arrowhead, CA

Sources for this page

Verify at the official NPI Registry.