Individual provider Active NPI

Mark S Humayun, M.D.

  • Ophthalmology Physician
  • Los Angeles, CA
National Provider Identifier
1548322381
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
A52637 Issued in CA
Practice address
1450 San Pablo St
Suite 4000
Los Angeles, CA 90033-4668
Phone
(323) 442-6311
Fax
(323) 442-7166
NPI assigned
Dec 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X A52637 CA Primary

Addresses

Primary practice location

1450 San Pablo St
Suite 4000
Los Angeles, CA 90033-4668

Mailing address

PO Box 31309
Los Angeles, CA 90031-0309
Phone (323) 442-7152

Other identifiers 1

IdentifierTypeStateIssuer
00A526370OtherCABLUE SHIELD

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mark.humayun@direct.usc.edu Direct USC CARE MEDICAL GROUP, INC

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091012000408 CA Practitioner - Ophthalmology 0840336475 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Duke University School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Usc Care Medical Group IncGroup PAC ID 0446157747, 1,378 clinicians

Practice addresses (Care Compare)

1450 San Pablo St
Los Angeles, CA 90033-4500
Phone (800) 872-2273

Hospital & facility affiliations

  • Keck Hospital of Usc Hospital, Los Angeles, CA, CCN 050696
  • Usc Kenneth Norris Jr Cancer Hospital Hospital, Los Angeles, CA, CCN 050660

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Usc Care Medical Group, Inc CurrentSince Aug 16, 2009 Accepting new patients
Usc Care Medical Group, Inc Ophthalmology CurrentSince Aug 16, 2009 Accepting new patients
Keck Medical Center of Usc Past Accepting new patients
Usc University Hospital, Inc. Past Accepting new patients
Usc Verdugo Hills Hospital, LLC Past Accepting new patients

Locations

1450 San Pablo St
Ste 4000
Los Angeles, CA 90033
Phone (323) 442-6335

1450 San Pablo St
Ste DEI4
Los Angeles, CA 90033

1450 San Pablo St
Fl 4
Los Angeles, CA 90033
Phone (323) 442-6335

1450 San Pablo St
Ste 4400
Los Angeles, CA 90033

1450 San Pablo St
Los Angeles, CA 90033
Phone (323) 442-6335

1520 San Pablo St
Los Angeles, CA 90033
Phone (323) 442-5849

Interoperability endpoints

  • Direct secure messaging: mark.humayun@direct.usc.edu

Organizations & group practices 5

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 2

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": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1548322381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31309",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900310309",
            "telephone_number": "323-442-7152",
            "fax_number": "323-442-7166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 SAN PABLO ST",
            "address_2": "SUITE 4000",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900334668",
            "telephone_number": "323-442-6311",
            "fax_number": "323-442-7166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUMAYUN",
        "first_name": "MARK",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-15",
        "last_updated": "2023-11-27",
        "certification_date": "2020-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "A52637",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00A526370",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mark.humayun@direct.usc.edu",
            "affiliation": "Y",
            "affiliationName": "USC CARE MEDICAL GROUP, INC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1450 San Pablo St",
            "address_2": "Suite 4000",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900334668",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.