NPIMap

Individual provider Active NPI

Mark Myungjae Song, MD, PHD

  • Nephrology Physician
  • Los Angeles, CA
National Provider Identifier
1326068560
Registry record updated Dec 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A49785 Issued in CA
Practice address
3663 W 6TH St Ste 307
Los Angeles, CA 90020-3050
Phone
(213) 736-1884
Fax
(714) 626-0800
NPI assigned
Jul 20, 2006
Last updated
Dec 1, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X A49785 CA Primary

Addresses

Primary practice location

3663 W 6TH St Ste 307
Los Angeles, CA 90020-3050

Mailing address

1401 S Brookhurst Rd Ste 100
Fullerton, CA 92833-4492
Phone (714) 626-0700

Other identifiers 1

IdentifierTypeStateIssuer
00A497850MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20061205000413 CA Practitioner - NephrologyPractitioner - Internal Medicine 9133128952 Reassigns benefits to 2 organizations
I20130813000114 CA Practitioner - Internal MedicinePractitioner - Nephrology 9133128952 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Nephrology
Education
Other, 1984
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1401 S Brookhurst Rd
Fullerton, CA 92833-4492
Phone (714) 626-0700

3663 W 6TH St
Los Angeles, CA 90020-3050
Phone (213) 736-1884

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Quality
92.9
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Quality
86.04
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Specialty Medical Center, Inc Nephrology CurrentSince Aug 4, 2006 Accepting new patients
Anaheim Memorial Medical Center Past Accepting new patients
Good Samaritan Hospital, L.P. Past Accepting new patients
Mark M. Song, M.D., Inc. Nephrology Past Accepting new patients
Mark M. Song M.D., Inc. Nephrology Past Accepting new patients

Locations

1401 S Brookhurst Rd
Ste 100
Fullerton, CA 92833
Phone (714) 441-0202

3663 W 6th St
Ste 307
Los Angeles, CA 90020
Phone (213) 389-2400

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: marksong@specialtymedicalcenter.ssdirect.aprima.com

Organizations & group practices 6

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 7

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": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322697600000",
    "number": "1326068560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 S BROOKHURST RD STE 100",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928334492",
            "telephone_number": "714-626-0700",
            "fax_number": "714-626-0800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3663 W 6TH ST STE 307",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900203050",
            "telephone_number": "213-736-1884",
            "fax_number": "714-626-0800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "MARK",
        "middle_name": "MYUNGJAE",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2011-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A49785",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A497850",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.