Samuel Alfonso Bolivar, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A188400 Issued in CA

Practice address

200 UCLA Medical PLZ Ste 420
Los Angeles, CA 90095-8358

Phone

(310) 206-6232

NPI assigned

Mar 30, 2022

Reactivated

May 9, 2022

Sex

Male

Sole proprietor

No

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.

• The Regents of the University of California

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1235107566

  CA, Internal Medicine

  Medicare reassignment Care Compare group NPD
• Venice Family Clinic

  • Federally Qualified Health Center (FQHC)
  • Venice, CA
  • NPI 1669418513

  CA

  Medicare reassignment Care Compare group NPD
• The Regents of the University of California

  • Ambulatory Surgical Clinic/Center
  • Valencia, CA
  • NPI 1689200305
  Care Compare group NPD
• Venice Family Clinic

  • Federally Qualified Health Center (FQHC)
  • Culver City, CA
  • NPI 1003842360
  Care Compare group NPD
• Venice Family Clinic

  • Federally Qualified Health Center (FQHC)
  • Venice, CA
  • NPI 1124054564
  Care Compare group NPD
• Venice Family Clinic

  • Federally Qualified Health Center (FQHC)
  • Hawthorne, CA
  • NPI 1518739515
  Care Compare group NPD
• Venice Family Clinic

  • Federally Qualified Health Center (FQHC)
  • Santa Monica, CA
  • NPI 1558397067
  Care Compare group NPD
• The Regents of the University of California

  • Ambulatory Surgical Clinic/Center
  • Thousand Oaks, CA
  • NPI 1205566544
  Care Compare group
• The Regents of the University of California

  • Ambulatory Surgical Clinic/Center
  • West Hills, CA
  • NPI 1215381843
  Care Compare group
• The Regents of the University of California

  • Durable Medical Equipment & Medical Supplies
  • Santa Monica, CA
  • NPI 1316522758
  Care Compare group
• The Regents of the University of California

  • Durable Medical Equipment & Medical Supplies
  • Los Angeles, CA
  • NPI 1316531197
  Care Compare group
• The Regents of the University of California

  • Ambulatory Surgical Clinic/Center
  • North Hollywood, CA
  • NPI 1366041469
  Care Compare group

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

• Regents Univ of Calif Los Angeles

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1902803315

  Hospital

  Care Compare affiliation

Specialty

Internal Medicine

Education

Loma Linda University School of Medicine, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Regents of the University of California 1,426 clinicians

Venice Family Clinic 101 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ronald Reagan UCLA Medical Center Hospital, Los Angeles, CA, CCN 050262

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 30, 2025.

{
    "created_epoch": "1648598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751241600000",
    "number": "1942940697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD SUITE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900958344",
            "telephone_number": "310-301-8707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 UCLA MEDICAL PLZ STE 420",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900958358",
            "telephone_number": "310-206-6232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLIVAR",
        "first_name": "SAMUEL",
        "middle_name": "ALFONSO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-30",
        "last_updated": "2025-06-30",
        "certification_date": "2025-06-30",
        "deactivation_date": "2022-03-30",
        "reactivation_date": "2022-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A188400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah Rebecca Boley, BS
• Sabrina Tuyet Bolin, LMFT
• Eric James Bautista Bolisay, MSN, APRN, FNP-BC
• Melissa Bolivar Escobar
• Barbara Bolivar, MD
• Margaret Boll
• Sacha Miran Bollas
• Keval Bollavaram
• Bradley Bollhagen
• Jessica Marion Bollinger

• All providers in Los Angeles, CA
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.