Mark Vincent Olivarez, MSN FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95005145 Issued in CA

Practice address

1817 N Kenwood St
Burbank, CA 91505-1418

Phone

(323) 540-3417

NPI assigned

Oct 14, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Baldwin Park, CA
  • NPI 1770515280
  Medicare reassignment NPD
• Valley Presbyterian Emergency Medical Associates

  • Emergency Medicine Physician
  • Van Nuys, CA
  • NPI 1033133103
  Medicare reassignment NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Los Angeles, CA
  • NPI 1043242563
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Santa Clarita, CA
  • NPI 1316409410
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634947200000",
    "number": "1396295325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1817 N KENWOOD ST",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915051418",
            "telephone_number": "323-540-3417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1817 N KENWOOD ST",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915051418",
            "telephone_number": "323-540-3417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLIVAREZ",
        "first_name": "MARK",
        "middle_name": "VINCENT",
        "name_prefix": "Mr.",
        "credential": "MSN FNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-10-14",
        "last_updated": "2021-10-23",
        "certification_date": "2021-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95005145",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "6041 Cadillac Ave",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900341702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Anahid Lily Ohanian
• Geoffrey Toshio Okada, D.D.S., M.S.
• Helen Okoh, M.D
• Gwendolyn Olicker, OTR/L
• Abigail Rosana Olivares
• Risa Quinto Olivarez, RN
• Olive Avenue Medical Pharmacy Inc
• Olive Crest Treatment Ctr.
• Olive Health Medical Group Inc
• Olive Health Pediatrics Inc

• Family Nurse Practitioner in Burbank, CA
• Providers in Burbank, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.