Marc Jezer Chan Gebala

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

F10170122 Issued in CA

Practice address

1241 E Dyer Rd Ste 145
Santa Ana, CA 92705-5694

Phone

(949) 538-2073

NPI assigned

Sep 24, 2018

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1537747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537747200000",
    "number": "1154805257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 W FOOTHILL BLVD UNIT 102",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917412452",
            "telephone_number": "626-841-1660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1241 E DYER RD STE 145",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927055694",
            "telephone_number": "949-538-2073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GEBALA",
        "first_name": "MARC JEZER",
        "middle_name": "CHAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-09-24",
        "last_updated": "2018-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CA",
            "license": "F10170122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erika Gavilanes
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• Alexis Geibler
• Geiss Med Hospice LLC
• John Mark Geiss, D.O.

• Primary Care Nurse Practitioner in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Primary Care Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2018; 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.