NPIMap

Individual provider Active NPI

Mark R Homicz, M.D.

  • Otolaryngology Physician
  • Santa Rosa, CA
National Provider Identifier
1336198449
Registry record updated Feb 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
A70413 Issued in CA
Practice address
1701 4TH St Ste 120
Santa Rosa, CA 95404-3661
Phone
(707) 523-7025
Fax
(707) 523-3024
NPI assigned
May 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X A70413 CA Primary
Plastic Surgery within the Head & Neck (Otolaryngology) Physician 207YX0007X A70413 CA

Addresses

Primary practice location

1701 4TH St Ste 120
Santa Rosa, CA 95404-3661

Mailing address

3536 Mendocino Ave
Ste 200
Santa Rosa, CA 95403-3634
Phone (707) 575-6049

Other identifiers 2

IdentifierTypeStateIssuer
00A704130OtherCABLUE SHIELD OF CALIFORNIA
P00933198OtherCARAILROAD MEDICARE

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
I20040831000679 CA Practitioner - Otolaryngology 0143295378 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Yale University School of Medicine, 1998
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Regents Univ of California UCSFGroup PAC ID 6305160300, 276 clinicians

Practice addresses (Care Compare)

505 Parnassus Ave
San Francisco, CA 94143-2204
Phone (415) 476-1000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.03 of 100Reported as subgroup
Quality
80.86
Promoting interoperability
76
Improvement activities
40
Cost
75.91

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A70413CAMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Santa Rosa Trauma Physicians Medical Group Otolaryngology Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mhomicz178916@direct-ucsfmedicalcenter.org
  • Direct secure messaging: mhomiczmd32469@hisp.ehr.sutterhealth.org

Organizations & group practices 2

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 5

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": "1147046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328572800000",
    "number": "1336198449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3536 MENDOCINO AVE",
            "address_2": "STE 200",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954033634",
            "telephone_number": "707-575-6049",
            "fax_number": "707-523-3024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 4TH ST STE 120",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954043661",
            "telephone_number": "707-523-7025",
            "fax_number": "707-523-3024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOMICZ",
        "first_name": "MARK",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-08",
        "last_updated": "2012-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "A70413",
            "primary": true
        },
        {
            "code": "207YX0007X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "CA",
            "license": "A70413",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CALIFORNIA",
            "identifier": "00A704130",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00933198",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.