NPIMap

Individual provider Active NPI

Marcus W. Hudock, PA-C

  • Physician Assistant
  • Concord, CA
National Provider Identifier
1285643213
Registry record updated Apr 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA15978 Issued in CA
Practice address
1001 Galaxy Way Ste 400
Concord, CA 94520-5725
Phone
(925) 225-5837
Fax
(925) 225-5838
NPI assigned
Aug 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Personal Emergency Response Attendant 146D00000X PA15978 CA
Physician Assistant 363A00000X PA15978 CA Primary

Addresses

Primary practice location

1001 Galaxy Way Ste 400
Concord, CA 94520-5725

Mailing address

1001 Galaxy Way Ste 400
Concord, CA 94520-5725
Phone (925) 225-5837

Other identifiers 1

IdentifierTypeStateIssuer
PA15978MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040607001121 CA Practitioner - Physician Assistant 2062494511 Reassigns benefits to 10 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
99.7
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
97.92 of 100Reported as group
Quality
87.42
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
88.38 of 100Reported as group
Quality
77.6
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA15978CAMDPhysician Assistant
15978CAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
County of Santa Clara CurrentSince Mar 19, 2021 Accepting new patients
County of Santa Clara CurrentSince Mar 19, 2021 Accepting new patients
Valley Emergency Physicians New Mexico PC Past Accepting new patients
Winterhaven Emergency Physicians Medical Group Inc Past Accepting new patients
Lakeport Emergency Medical Corporation Past Accepting new patients
Vepema Medical Group Past Accepting new patients
Memorial Emergency Physicians Medical Group, Inc Past Accepting new patients

Locations

751 S Bascom Ave
San Jose, CA 95128
Phone (408) 885-5110

Interoperability endpoints

  • Direct secure messaging: mhudock86531@santaclaravalley.direct-ci.net

Organizations & group practices 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554768000000",
    "number": "1285643213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 GALAXY WAY STE 400",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945205725",
            "telephone_number": "925-225-5837",
            "fax_number": "925-225-5838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 GALAXY WAY STE 400",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945205725",
            "telephone_number": "925-225-5837",
            "fax_number": "925-225-5838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUDOCK",
        "first_name": "MARCUS",
        "middle_name": "W.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-07",
        "last_updated": "2019-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146D00000X",
            "taxonomy_group": "",
            "desc": "Personal Emergency Response Attendant",
            "state": "CA",
            "license": "PA15978",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA15978",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PA15978",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, CA

Sources for this page

Verify at the official NPI Registry.