Individual provider Active NPI

Mark Evan Landau, MD

  • Neurology Physician
  • Kailua, HI
National Provider Identifier
1447366349
Registry record updated Aug 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
MD-10542 Issued in HI
Practice address
1331 Auwaiku St
Kailua, HI 96734-4106
Phone
(800) 348-4565
Fax
(888) 203-4247
NPI assigned
Aug 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2022

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X DR.0065895 CO
Neurology Physician 2084N0400X ME153565 FL
Neurology Physician 2084N0400X MD2021-0447 NM
Clinical Neurophysiology Physician 2084N0600X 48556 VA
Neurology Physician 2084N0400X MD-10542 HI Primary

Addresses

Primary practice location

1331 Auwaiku St
Kailua, HI 96734-4106

Mailing address

3 Maryland Farms Ste 200
Brentwood, TN 37027-5780
Phone (800) 348-4565

Other practice location 1

777 Bannock St
Denver, CO 80204-4507
Phone (303) 436-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI, CO2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210826002599 HI Practitioner - Neurology 8426280538 Reassigns benefits to 2 organizations
I20221201003409 CO Practitioner - Psychiatry 8426280538 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME153565FLMDNeurology Physician
MD2021-0447NMMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Denver Health and Hospital Authority CurrentSince Sep 1, 2022 Accepting new patients
Denver Health and Hospital Authority CurrentSince Sep 1, 2022 Accepting new patients
Remote Neuromonitoring Physicians ,PC Neurology CurrentSince Jul 1, 2021 Accepting new patients
Sentient Physicians, P.C. Neurology CurrentSince Jul 1, 2021 Accepting new patients

Locations

777 Bannock St
Denver, CO 80204

3 Maryland Farms
Ste 200
Brentwood, TN 37027
Phone (615) 346-8733

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: mlandau604884@hisp.ehr.sutterhealth.org

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1447366349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 MARYLAND FARMS STE 200",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275780",
            "telephone_number": "800-348-4565",
            "fax_number": "888-203-4247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1331 AUWAIKU ST",
            "city": "KAILUA",
            "state": "HI",
            "postal_code": "967344106",
            "telephone_number": "800-348-4565",
            "fax_number": "888-203-4247"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "777 Bannock St",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802044507",
            "country_code": "US",
            "telephone_number": "303-436-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LANDAU",
        "first_name": "MARK",
        "middle_name": "EVAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CO",
            "license": "DR.0065895",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "ME153565",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NM",
            "license": "MD2021-0447",
            "primary": false
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "VA",
            "license": "48556",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "HI",
            "license": "MD-10542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kailua, HI

Sources for this page

Verify at the official NPI Registry.