Active NPI
Mark Elliot Watters, DC
- Chiropractor
- Mission Viejo, CA
National Provider Identifier
1386742625
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 14805
- Practice address
- 25571 Jeronimo Rd
#15
Mission Viejo, CA 92691 - Phone
- (949) 768-6111
- Fax
- (949) 768-6104
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 14805 | CA | Primary |
Addresses
Primary practice location
25571 Jeronimo Rd
#15
Mission Viejo, CA 92691
Mailing address
25571 Jeronimo Rd
#15
Mission Viejo, CA 92691
Phone (949) 768-6111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080512000322 | CA | Practitioner - Chiropractic | 2466531702 | Practice locations: Mission Viejo, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Los Angeles College of Chiropractic, 1982
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
25571 Jeronimo Rd
Suite 15
Mission Viejo, CA 92691-2726
Phone (949) 768-6111
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14805 | CA | MD | Physical Rehabilitation Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1237939200000",
"number": "1386742625",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25571 JERONIMO RD",
"address_2": "#15",
"city": "MISSION VIEJO",
"state": "CA",
"postal_code": "92691",
"telephone_number": "949-768-6111",
"fax_number": "949-768-6104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25571 JERONIMO RD",
"address_2": "#15",
"city": "MISSION VIEJO",
"state": "CA",
"postal_code": "92691",
"telephone_number": "949-768-6111",
"fax_number": "949-768-6104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATTERS",
"first_name": "MARK",
"middle_name": "ELLIOT",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2009-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "14805",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mission Viejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.