NPIMap

Individual provider Active NPI

Kyle Elliott Mock, MD

  • Surgical Critical Care Physician
  • Los Angeles, CA
National Provider Identifier
1588911085
Registry record updated Nov 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Critical Care PhysicianTaxonomy code 2086S0102X
License
A129020 Issued in CA
Practice address
1500 San Pablo St FL 7
Los Angeles, CA 90033-5313
Phone
(323) 442-6254
NPI assigned
Aug 14, 2012
Last updated
Nov 5, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 18141 NV
Surgical Critical Care Physician 2086S0102X A129020 CA Primary

Addresses

Primary practice location

1500 San Pablo St FL 7
Los Angeles, CA 90033-5313

Mailing address

PO Box 31309
Los Angeles, CA 90031-0309
Phone (323) 442-6254

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kyle.mock@direct.usc.edu Direct USC CARE MEDICAL GROUP, INC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NV2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20151221002112 CA Practitioner - General Surgery 7214238013 Reassigns benefits to 1 organization
I20190920003157 NV Practitioner - General Surgery 7214238013 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Care Services LLCGroup PAC ID 1951324318, 630 clinicians

Practice addresses (Care Compare)

10101 Double R Blvd
Reno, NV 89521-5931
Phone (775) 982-7878

1155 Mill St
Reno, NV 89502-1576
Phone (775) 982-4000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
18141NVMDSurgery Physician
A129020CAMDSurgical Critical Care Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care Services LLC CurrentSince Apr 10, 2022 Accepting new patients
Community Care Services LLC CurrentSince Apr 10, 2022 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Aug 1, 2020 Accepting new patients
Community Care Services LLC Current Accepting new patients
Gomez Kozar McElreath Smith Surgery CurrentSince Feb 1, 2022 Accepting new patients
Usc Care Medical Group, Inc Surgery CurrentSince Aug 1, 2020 Accepting new patients
Renown Regional Medical Center Past Accepting new patients
Desert Springs Hospital Past Accepting new patients
Dignity Health Past Accepting new patients
Centennial Hills Hospital Medical Center Past Accepting new patients
Lubbock County Hospital District Past Accepting new patients
Sunrise Mountainview Hospital, Inc. Past Accepting new patients
Community Care Services LLC Past Accepting new patients

Locations

420 34th St
Bakersfield, CA 93301
Phone (661) 324-4647

1450 San Pablo St
Ste HC46200
Los Angeles, CA 90033

1500 San Pablo St
Fl 7
Los Angeles, CA 90033
Phone (323) 409-7761

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

10315 Professional Cir
Reno, NV 89521
Phone (775) 982-5860

1155 Mill St
Reno, NV 89502
Phone (775) 982-7878

75 Pringle Way
Ste 1002
Reno, NV 89502
Phone (702) 323-7500

Interoperability endpoints

  • Direct secure messaging: kmock186665@direct.renown.org
  • Direct secure messaging: kyle.mock@direct.usc.edu

Organizations & group practices 13

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 13

Hospital & facility affiliations 4

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": "1344902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604534400000",
    "number": "1588911085",
    "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": "323-442-6254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 SAN PABLO ST FL 7",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900335313",
            "telephone_number": "323-442-6254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOCK",
        "first_name": "KYLE",
        "middle_name": "ELLIOTT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-14",
        "last_updated": "2020-11-05",
        "certification_date": "2020-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NV",
            "license": "18141",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "CA",
            "license": "A129020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kyle.mock@direct.usc.edu",
            "affiliation": "Y",
            "affiliationName": "USC CARE MEDICAL GROUP, INC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1500 San Pablo St Fl 7",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900335313",
            "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.