Individual provider Active NPI

Marco Antonio Ruiz, M.D.

  • Family Medicine Physician
  • Huntington Beach, CA
National Provider Identifier
1942658752
Registry record updated Jul 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A158850 Issued in CA
Practice address
17762 Beach Blvd Ste 220
Huntington Beach, CA 92647-6860
Phone
(714) 848-0080
Fax
(714) 665-4679
NPI assigned
Jun 2, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2020

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 A158850 CA Primary

Addresses

Primary practice location

17762 Beach Blvd Ste 220
Huntington Beach, CA 92647-6860

Mailing address

17762 Beach Blvd Ste 220
Huntington Beach, CA 92647-6860
Phone (714) 848-0080

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
I20200713002109 CA Practitioner - Family Practice 9830512623 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Texas Tech University Health Science Center School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Memorialcare Medical FoundationGroup PAC ID 8729277314, 555 clinicians

Practice addresses (Care Compare)

17762 Beach Blvd
Suite 220
Huntington Beach, CA 92647-6860
Phone (714) 848-0080

Hospital & facility affiliations

  • Memorialcare Orange Coast Medical Center Hospital, Fountain Valley, CA, CCN 050678

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A158850CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorialcare Medical Foundation Family Medicine CurrentSince Aug 1, 2020 Accepting new patients
Bristol Park Medical Group, Inc Family Medicine PastSince Aug 1, 2020 Accepting new patients

Locations

722 Baker St
Costa Mesa, CA 92626
Phone (714) 557-6300

17360 Brookhurst St
Fountain Vly, CA 92708
Phone (657) 241-3592

17762 Beach Blvd
Ste 100
Huntington Beach, CA 92647
Phone (714) 848-0080

17762 Beach Blvd
Ste 220
Huntington Beach, CA 92647
Phone (714) 848-0080

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: mruiz633093@direct.memorialcare.org

Organizations & group practices 2

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.

Hospital & facility affiliations 1

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": "1464825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594166400000",
    "number": "1942658752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17762 BEACH BLVD STE 220",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926476860",
            "telephone_number": "714-848-0080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17762 BEACH BLVD STE 220",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926476860",
            "telephone_number": "714-848-0080",
            "fax_number": "714-665-4679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUIZ",
        "first_name": "MARCO",
        "middle_name": "ANTONIO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-02",
        "last_updated": "2020-07-08",
        "certification_date": "2020-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A158850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntington Beach, CA

Sources for this page

Verify at the official NPI Registry.