Mark Jason Joel San Jose

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

95027777 Issued in CA

Practice address

101 The City Dr S
Orange, CA 92868-3201

Phone

(800) 465-3203

NPI assigned

Oct 23, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: msanjose10735@cityofhope.direct-ci.com

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.

• City of Hope Medical Foundation

  • Hematology & Oncology Physician
  • Duarte, CA
  • NPI 1871886366
  Medicare reassignment NPD
• Regents of the University of

  • Anesthesiology Physician
  • Orange, CA
  • NPI 1487602546
  Medicare reassignment NPD
• University of California Irvine

  • Infusion Therapy Clinic/Center
  • Irvine, CA
  • NPI 1417027475
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1698019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727395200000",
    "number": "1043082233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "UC IRVINE MEDICAL CENTER",
            "address_2": "101 THE CITY DRIVE SOUTH",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683201",
            "telephone_number": "800-465-3203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 THE CITY DR S",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683201",
            "telephone_number": "800-465-3203"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15960 Serenade Ln",
            "address_purpose": "LOCATION",
            "city": "Fontana",
            "state": "CA",
            "postal_code": "923365076",
            "country_code": "US",
            "telephone_number": "847-222-3113",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAN JOSE",
        "first_name": "MARK JASON JOEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-10-23",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CA",
            "license": "95027777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gurmanjot Kaur Samra, M.D.
• Jenesagrace Lozano Samson
• Michael Samson
• Jenna Samuels, LMFT 85477
• Keola San Diego
• Vy Ngoc San
• Sanaz Shahbandi DDS a Professional Corporation
• Antonio Dejesus Sanchez Bautista
• Kimberly Sanchez Gonzalez
• Siria Sanchez Neri

• Acute Care Nurse Practitioner in Orange, CA
• Providers in Orange, CA by specialty
• Acute Care Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.