SAMUEL ALFONSO BOLIVAR MD
NPI 1942940697
Student in an Organized Health Care Education/Training Program in Los Angeles, CA
About Samuel Alfonso Bolivar Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SAMUEL ALFONSO BOLIVAR MD (NPI 1942940697) is an individual student in an organized health care education/training program in Los Angeles, California and active in the NPI registry since March 2022. He is enrolled in Medicare PECOS and is a graduate of Loma Linda University School Of Medicine (2022).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Samuel Alfonso Bolivar Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
2Medicare enrollment records show Samuel Bolivar reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Los Angeles, CA 90095
- Reassigned Medicare billing, California enrollment
- 1,766 clinicians in this Medicare group
Santa Monica, CA 90405
- Reassigned Medicare billing, California enrollment
- 147 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
LOS ANGELES, CA 90095
LOS ANGELES, CA 90095
LOS ANGELES, CA 90095
LOS ANGELES, CA 90095
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Samuel Bolivar's NPI number?
The NPI number for Samuel Bolivar is 1942940697. It was assigned to this individual provider in the NPPES registry on March 30, 2022.
Where is Samuel Bolivar located?
Samuel Bolivar practices at 757 Westwood Plz, Los Angeles, CA 90095. The listed phone number is (310) 825-7375.
What is Samuel Bolivar's specialty?
The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.
Is Samuel Bolivar enrolled in Medicare?
Yes. Samuel Bolivar is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Samuel Bolivar's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Samuel Bolivar reassigns Medicare benefits to 2 organizations: The Regents Of The University Of California (Los Angeles, CA) and Venice Family Clinic (Santa Monica, CA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Samuel Bolivar's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Samuel Bolivar was last updated on May 9, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Samuel Alfonso Bolivar, MD · NPI 1942940697
Student in an Organized Health Care Education/Training Program provider in Los Angeles, California. Individual provider, active in the CMS NPPES registry since March 30, 2022.
## Identity
- **NPI:** 1942940697 (Entity type: Individual)
- **Enumerated:** March 30, 2022
- **Primary specialty:** Student in an Organized Health Care Education/Training Program · taxonomy 390200000X
- **Sole proprietor:** No
## Practice location
- **Address:** 757 WESTWOOD PLZ, Los Angeles, CA 90095-8358
- **Phone:** (310) 825-7375
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): The Regents Of The University Of California (NPI 1235107566, Los Angeles, CA); Venice Family Clinic (NPI 1558397067, Santa Monica, CA) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Loma Linda University School Of Medicine, class of 2022
## Record status
- **NPPES last updated:** May 9, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1942940697) · Data from the CMS NPPES public registry.