NPIMap

Organization Active NPI

Mark a. Latina

  • Ophthalmology Physician
  • Reading, MA
National Provider Identifier
1508839291
Registry record updated Dec 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
48630 Issued in MA
Legal business name
MARK A. LATINA
Doing business as
Advanced Glaucoma Specialists
Practice address
20 Pondmeadow Drive
Suite 203
Reading, MA 01867
Phone
(781) 942-9876
Fax
(781) 942-9877
NPI assigned
Feb 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2010

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

Authorized official

Name
Dr. Mark A Latina, MDNPI 1801886346
Title
Owner
Phone
(781) 941-9876

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X 48630 MA Primary

Addresses

Primary practice location

20 Pondmeadow Drive
Suite 203
Reading, MA 01867

Mailing address

20 Pondmeadow Drive
Suite 203
Reading, MA 01867
Phone (781) 942-9876

Other identifiers 5

IdentifierTypeStateIssuer
977865MedicaidMA
M16360OtherMABC/BS GROUP NUMBER
607152OtherMATUFTS HEALTH PLAN GROUP N
9777865MedicaidMA
8488OtherFALLON

Other names 1

  • Advanced Glaucoma Specialists Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040813000811 MA Part B Supplier - Clinic/Group Practice 2567435019 Receives reassigned benefits from 10 practitioners
Practice locations: Reading, MA; Wakefield, MA

National Provider Directory

National Provider Directory
Tax ID family
Advanced Glaucoma Specialists2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

467 Main St
Melrose, MA 02176
Phone (781) 662-2276

607 North Ave
Side
Wakefield, MA 01880

607 North Ave
Bldg F
Wakefield, MA 01880

607 North Ave
Ste 15
Wakefield, MA 01880

607 North Ave
Ste 149
Wakefield, MA 01880

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1139616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291248000000",
    "number": "1508839291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 PONDMEADOW DRIVE",
            "address_2": "SUITE 203",
            "city": "READING",
            "state": "MA",
            "postal_code": "01867",
            "telephone_number": "781-942-9876",
            "fax_number": "781-942-9877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 PONDMEADOW DRIVE",
            "address_2": "SUITE 203",
            "city": "READING",
            "state": "MA",
            "postal_code": "01867",
            "telephone_number": "781-942-9876",
            "fax_number": "781-942-9877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK A. LATINA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-11",
        "last_updated": "2010-12-02",
        "status": "A",
        "authorized_official_last_name": "LATINA",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "781-941-9876",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "MA",
            "license": "48630",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "977865",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS GROUP NUMBER",
            "identifier": "M16360",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN GROUP N",
            "identifier": "607152",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9777865",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FALLON",
            "identifier": "8488",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Glaucoma Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Reading, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.