NPIMap

Marlon S Bazan, PA-C

Individual provider Active NPI Medical Physician Assistant · Liberal, KS

NPI 1306329438 · NPPES record last updated Sep 14, 2018

Key facts

NPI
1306329438
Entity type
Individual (NPI type 1)
Primary specialty
Medical Physician Assistant 363AM0700X
License
1502129 (KS)
Practice address
315 W 15TH St
Liberal, KS 67901-2455
Phone
(620) 629-6477
Fax
(620) 629-6651
NPI assigned
Sep 14, 2018
Sex
Male
Sole proprietor
No

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.

Hospital & facility affiliations 2

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

Medicare Care Compare profile

Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sound Physicians of Wyoming LLC (41 clinicians)
Summit Hospitalist Group LLC (47 clinicians)
Cottage Clinical Network LLC (57 clinicians)

Practice addresses (Care Compare)

1233 E 2ND St
Casper, WY 82601-2926
Phone (800) 822-7201

214 E 23Rd St
Cheyenne, WY 82001-3748
Phone (307) 324-2221

3970 Broad St
Suite 2
San Luis Obispo, CA 93401-7097
Phone (805) 762-4996

Hospital & facility affiliations

  • Banner Wyoming Medical Center Hospital · Casper, WY · CCN 530012
  • Lompoc Valley Medical Center Hospital · Lompoc, CA · CCN 050110

Medicare participation

Medicare fee-for-service enrollment
Enrolled (4 enrollments) in KS, ND, CA, WY
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20181025001983 KS Practitioner - Physician Assistant 8224381983 Reassigns benefits to 1 organization
I20200425000238 ND Practitioner - Physician Assistant 8224381983 Reassigns benefits to 1 organization
I20200720000160 CA Practitioner - Physician Assistant 8224381983 Reassigns benefits to 7 organizations
I20240923001120 WY Practitioner - Physician Assistant 8224381983 Reassigns benefits to 2 organizations

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation Current
since Mar 21, 2024		 Accepting new patients
Southwest Medical Center Current
since Sep 15, 2018		 Accepting new patients
Southwest Medical Center Current
since Sep 15, 2018		 Accepting new patients
St Joseph'S Hospital and Health Center Current
since Mar 1, 2020		 Accepting new patients
Providence Medical Foundation Current
since Mar 21, 2024		 Accepting new patients
St Josephs Hospital and Health Center Current
since Mar 1, 2020		 Accepting new patients

Locations

500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842

1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210

7360 Solutions Ctr
Chicago, IL 60677
Phone (701) 237-8033

315 W 15th St
Liberal, KS 67901
Phone (620) 624-1651

2500 Fairway St
Dickinson, ND 58601
Phone (701) 456-4000

Interoperability endpoints

  • Direct secure messaging: bazamar@directswmedcenter.com

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 1502129 KS Yes

Addresses

Primary practice location

315 W 15TH St
Liberal, KS 67901-2455

Mailing address

PO Box 1340
Liberal, KS 67905-1340
Phone (620) 629-6638

Other providers in Liberal, KS

All providers in Liberal, KS · Medical Physician Assistant in Kansas

Sources for this page

Verify at the official NPI Registry.