SAMUEL ALFONSO BOLIVAR MD
NPI 1942940697
Student in an Organized Health Care Education/Training Program in Los Angeles, CA

Active since March 30, 2022PECOS EnrolledAccepts Medicare Assignment
757 WESTWOOD PLZ, LOS ANGELES, CA 90095(310) 825-7375 Get Directions Write a Review

NPPES record last updated: May 9, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 30, 2025, May 9, 2022 (2 updates tracked since 2022).

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

NPI1942940697
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameSAMUEL ALFONSO BOLIVARCredential: MD
Location Address757 WESTWOOD PLZLos Angeles, CA 90095-8358
Mailing Address757 Westwood PlzLos Angeles, CA 90095-7419 · (310) 825-7375
Sole ProprietorNo
Medical School CMSLoma Linda University School Of MedicineGraduated 2022
Enumeration DateMarch 30, 2022
Last NPPES UpdateMay 9, 20222 updates tracked since enumeration
NPPES CertifiedMay 9, 2022
NPI 1942940697 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
757 WESTWOOD PLZ, Los Angeles, CA 90095

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

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.

PECOS PAC ID4082125687
PECOS Enrollment IDI20250619000129
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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.

Anesthesiology
757 WESTWOOD PLZ
LOS ANGELES, CA 90095
Pediatrics
757 WESTWOOD PLZ, B711 RRUMC
LOS ANGELES, CA 90095
Anesthesiology
757 WESTWOOD PLZ
LOS ANGELES, CA 90095
Internal Medicine
757 WESTWOOD PLZ
LOS ANGELES, CA 90095
Urology
757 WESTWOOD PLZ
LOS ANGELES, CA 90095
Student in an Organized Health Care Education/Training Program
757 WESTWOOD PLZ
LOS ANGELES, CA 90095
Student in an Organized Health Care Education/Training Program
757 WESTWOOD PLZ
LOS ANGELES, CA 90095
Student in an Organized Health Care Education/Training Program
757 WESTWOOD PLZ
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.

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.