Active NPI
Ronald J Policastro, M.D.
- Gastroenterology Physician
- Fountain Valley, CA
National Provider Identifier
1962671636
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- G40687
- Practice address
- 18111 Brookhurst St
Ste 5200
Fountain Valley, CA 92708-6728 - Phone
- (714) 962-7705
- Fax
- (714) 962-7701
- NPI assigned
- Feb 26, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | G40687 | CA | Primary |
Addresses
Primary practice location
18111 Brookhurst St
Ste 5200
Fountain Valley, CA 92708-6728
Mailing address
18111 Brookhurst St
Ste 5200
Fountain Valley, CA 92708-6728
Phone (714) 962-7705
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G406870 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40687 | CA | MD | Marriage & Family Therapist |
| G40687 | CA | MD | Gastroenterology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203984000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1279843200000",
"number": "1962671636",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18111 BROOKHURST ST",
"address_2": "STE 5200",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "927086728",
"telephone_number": "714-962-7705",
"fax_number": "714-962-7701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18111 BROOKHURST ST",
"address_2": "STE 5200",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "927086728",
"telephone_number": "714-962-7705",
"fax_number": "714-962-7701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLICASTRO",
"first_name": "RONALD",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-02-26",
"last_updated": "2010-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "CA",
"license": "G40687",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G406870",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fountain Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.