NPIMap

Individual provider Active NPI

Noachim Marco, M.D.

  • Internal Medicine Physician
  • Reseda, CA
National Provider Identifier
1366848335
Registry record updated Nov 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G60305 Issued in CA
Practice address
18855 Victory Blvd
Reseda, CA 91335-6445
Phone
(818) 774-3032
Fax
(818) 774-5919
NPI assigned
Nov 18, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X G60305 CA Primary

Addresses

Primary practice location

18855 Victory Blvd
Reseda, CA 91335-6445

Mailing address

7150 Tampa Ave
Reseda, CA 91335-3700
Phone (818) 774-3032

Other identifiers 1

IdentifierTypeStateIssuer
G60305OtherCACA STATE LICENSE

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
I20150126000360 CA Practitioner - Internal Medicine 4981928876 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of California, Davis School of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jha Geriatric Services IncGroup PAC ID 2062321151, 9 clinicians

Practice addresses (Care Compare)

18855 Victory Blvd
Reseda, CA 91335-6445
Phone (818) 774-3139

7150 Tampa Ave
Reseda, CA 91335-3700

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G60305CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jha Geriatric Services, Inc CurrentSince Nov 24, 2014 Accepting new patients
Jha Geriatric Services, Inc CurrentSince Nov 24, 2014 Accepting new patients
Jha Geriatric Services, Inc Past Accepting new patients

Locations

18855 Victory Blvd
Reseda, CA 91335
Phone (818) 774-3000

7150 Tampa Ave
Reseda, CA 91335
Phone (818) 757-4447

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Joyce Eisenberg Keefer Medical CenterReseda, CA, CCN 054147 Hospital Corporate Officer
W-2 Managing Employee		 Nov 3, 2014
Nov 3, 2014
Joyce Eisenberg Keefer Medical CenterReseda, CA, CCN 555846 Skilled nursing facility Corporate Officer
Operational/Managerial Control
Adp of the SNF		 Nov 3, 2014
Nov 3, 2014
Nov 3, 2014
Eisenberg VillageReseda, CA, CCN 055013 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Nov 3, 2014
Nov 3, 2014

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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 4

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": "1416268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416268800000",
    "number": "1366848335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7150 TAMPA AVE",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913353700",
            "telephone_number": "818-774-3032",
            "fax_number": "818-774-5919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18855 VICTORY BLVD",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913356445",
            "telephone_number": "818-774-3032",
            "fax_number": "818-774-5919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARCO",
        "first_name": "NOACHIM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-11-18",
        "last_updated": "2014-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G60305",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA STATE LICENSE",
            "identifier": "G60305",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Reseda, CA

Sources for this page

Verify at the official NPI Registry.