Individual provider Active NPI

Luke Macyszyn, MD, MA

  • Neurological Surgery Physician
  • Marina del Rey, CA
National Provider Identifier
1225291842
Registry record updated Mar 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
A137191 Issued in CA
Practice address
4551 Glencoe Ave Ste 145
Marina del Rey, CA 90292-6385
Phone
(424) 835-3100
NPI assigned
Jul 3, 2008
Last updated
Mar 13, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X MT193440 PA
Neurological Surgery Physician 207T00000X A137191 CA Primary

Addresses

Primary practice location

4551 Glencoe Ave Ste 145
Marina del Rey, CA 90292-6385

Mailing address

PO Box 3129
Torrance, CA 90510-3129
Phone (310) 792-3914

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NV2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150729009776 CA Practitioner - Neurosurgery 5496069825 Reassigns benefits to 1 organization
I20250228000615 NV Practitioner - Neurosurgery 5496069825 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Boston University School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Luke Macyszyn MD IncGroup PAC ID 2769850577, 2 clinicians

Practice addresses (Care Compare)

16830 Ventura Blvd
Suite 220
Encino, CA 91436-1723
Phone (424) 835-3100

4551 Glencoe Ave
Suite 145
Marina del Rey, CA 90292-6385
Phone (424) 835-3100

9159 W Flamingo Rd
Suite 100
Las Vegas, NV 89147-6454
Phone (702) 307-7700

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion36
Laminectomy or laminotomy (partial removal of spine bones)52

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A137191CAMDNeurological Surgery Physician
MT193440PAMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Luke Macyszyn MD Inc Neurological Surgery CurrentSince Oct 1, 2022 Accepting new patients
Macyszyn MD, Inc. Neurological Surgery Current Accepting new patients
Trias Global, LLC Past Accepting new patients

Locations

16830 Ventura Blvd
Ste 220
Encino, CA 91436
Phone (424) 438-0881

4551 Glencoe Ave
Ste 145
Marina del Rey, CA 90292
Phone (310) 426-8206

4553 Glencoe Ave
Ste 140
Marina del Rey, CA 90292
Phone (424) 786-1379

3501 Jamboree Rd
Ste 1250
Newport Beach, CA 92660
Phone (310) 773-3427

9159 W Flamingo Rd
Ste 100
Las Vegas, NV 89147
Phone (702) 307-7700

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1215043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710288000000",
    "number": "1225291842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3129",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905103129",
            "telephone_number": "310-792-3914",
            "fax_number": "855-898-4055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4551 GLENCOE AVE STE 145",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926385",
            "telephone_number": "424-835-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACYSZYN",
        "first_name": "LUKE",
        "name_prefix": "Dr.",
        "credential": "MD, MA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-03",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "PA",
            "license": "MT193440",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "CA",
            "license": "A137191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marina del Rey, CA

Sources for this page

Verify at the official NPI Registry.