NPIMap

Organization Active NPI

Amplify Physicians of California PC

  • Optometrist
  • Los Angeles, CA
National Provider Identifier
1124866959
Registry record updated Jul 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
AMPLIFY PHYSICIANS OF CALIFORNIA PC
Practice address
4403 S Vermont Ave
Los Angeles, CA 90037-2413
Phone
(323) 232-1234
NPI assigned
Jul 16, 2024
Organization subpart
Yes
Parent organization
AMPLIFY PHYSICIANS OF CALIFORNIA PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 16, 2024

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

Authorized official

Name
David Bruce Mark, MDNPI 1912900218
Title
Owner
Phone
(408) 739-6200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X Primary
Ophthalmology Physician 207W00000X
Clinic/Center 261Q00000X

Addresses

Primary practice location

4403 S Vermont Ave
Los Angeles, CA 90037-2413

Mailing address

6125 Luther LN # 572
Dallas, TX 75225-6202
Phone (312) 608-4584

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240801002866 CA Part B Supplier - Clinic/Group Practice 5092252593 Receives reassigned benefits from 17 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Los Angeles, CA; Sunnyvale, CA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Amplify Physicians of Cali3 organizations share this tax ID, including this one
Part of
Amplify Physicians of Cali

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1721088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721088000000",
    "number": "1124866959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6125 LUTHER LN # 572",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752256202",
            "telephone_number": "312-608-4584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4403 S VERMONT AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900372413",
            "telephone_number": "323-232-1234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMPLIFY PHYSICIANS OF CALIFORNIA PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AMPLIFY PHYSICIANS OF CALIFORNIA PC",
        "enumeration_date": "2024-07-16",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A",
        "authorized_official_last_name": "MARK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "BRUCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "408-739-6200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.