Individual provider Active NPI

Mark Masaru Urata, MD DDS

  • Plastic and Reconstructive Surgery Physician
  • Los Angeles, CA
National Provider Identifier
1235234857
Registry record updated Dec 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
A64497 Issued in CA
Practice address
4650 W Sunset Blvd
Los Angeles, CA 90027-6062
Phone
(888) 631-2452
Fax
(323) 361-8988
NPI assigned
Sep 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery Physician 2086S0122X A64497 CA Primary

Addresses

Primary practice location

4650 W Sunset Blvd
Los Angeles, CA 90027-6062

Mailing address

PO Box 31309
Los Angeles, CA 90031-0309
Phone (323) 442-7920

Other practice location 1

1450 San Pablo St Ste 6200
Los Angeles, CA 90033
Phone (323) 442-7920

Other practice location 2

1450 San Pablo St Ste 6200
Los Angeles, CA 90033
Phone (323) 442-7920

Other identifiers 1

IdentifierTypeStateIssuer
00A644970MedicaidCA

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050414001327 CA Practitioner - Plastic and Reconstructive SurgeryPractitioner - Oral Surgery 0446297964 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive SurgeryAlso: Oral Surgery
Education
University of Southern California Keck School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Childrens Hospital Los Angeles Medical Group IncGroup PAC ID 0143126920, 288 clinicians

Practice addresses (Care Compare)

4650 W Sunset Blvd
Los Angeles, CA 90027-6062
Phone (323) 361-8408

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Hospital Los Angeles Medical Group, Inc. CurrentSince Mar 8, 2010 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Jul 1, 2009 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Jul 1, 2009 Accepting new patients
Pasadena Hospital Association, LTD. Past Accepting new patients
Usc University Hospital, Inc. Past Accepting new patients
Cedars-Sinai Medical Center Past Accepting new patients
Children'S Hospital Los Angeles Past Accepting new patients
Providence Saint John'S Health Center Past Accepting new patients
Childrens Hospital of Los Angeles Past Accepting new patients
Cha Hollywood Medical Center, LP Past Accepting new patients
Keck Medical Center of Usc Past Accepting new patients
Usc Verdugo Hills Hospital, LLC Past Accepting new patients
Childrens Hospital Medical Practice Corporation Past Accepting new patients

Locations

221 E Glenoaks Blvd
Ste 140
Glendale, CA 91207
Phone (818) 807-8884

1450 San Pablo St
Ste 6200
Los Angeles, CA 90033
Phone (323) 442-7920

1520 San Pablo St
Los Angeles, CA 90033
Phone (323) 442-5849

4650 W Sunset Blvd
Los Angeles, CA 90027
Phone (323) 361-2122

1301 20th St
Ste 460
Santa Monica, CA 90404
Phone (310) 315-0121

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: murata473475@oc.providencedirect.org

Organizations & group practices 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545264000000",
    "number": "1235234857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31309",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900310309",
            "telephone_number": "323-442-7920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4650 W SUNSET BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276062",
            "telephone_number": "888-631-2452",
            "fax_number": "323-361-8988"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1450 San Pablo St Ste 6200",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "90033",
            "country_code": "US",
            "telephone_number": "323-442-7920",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1450 San Pablo St Ste 6200",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "90033",
            "country_code": "US",
            "telephone_number": "323-442-7920",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "URATA",
        "first_name": "MARK",
        "middle_name": "MASARU",
        "credential": "MD DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2018-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "CA",
            "license": "A64497",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A644970",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.