Active NPI
Mark W Penn, M.D.
- Family Medicine Physician
- La Mesa, CA
National Provider Identifier
1639205255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- G131027
- Practice address
- 8080 Parkway Dr
La Mesa, CA 91942-2104 - Phone
- (800) 528-5000
- NPI assigned
- Feb 26, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036085370 | IL | |
| Family Medicine Physician | 207Q00000X | G131027 | CA | Primary |
Addresses
Primary practice location
8080 Parkway Dr
La Mesa, CA 91942-2104
Mailing address
8080 Parkway Dr
La Mesa, CA 91942-2104
Phone (800) 528-5000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 131027 | CA | MD | Social Worker |
| G131027 | CA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medspring of Texas, PA | Past | Accepting new patients | |
| Emergency Care Physician Services-Blue Island LTD | Past | Accepting new patients |
Interoperability endpoints
- mark.pennmd.p1@direct.vistacommunityclinic.nextgenshare.com
- mark.penn.p5@direct.mydohc.nextgenshare.com
Organizations & group practices 2
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.
-
- Emergency Medicine Physician
- Blue Island, IL
- NPI 1558524793
-
- Urgent Care Clinic/Center
- Austin, TX
- NPI 1811286354
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447200000000",
"number": "1639205255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8080 PARKWAY DR",
"city": "LA MESA",
"state": "CA",
"postal_code": "919422104",
"telephone_number": "800-528-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8080 PARKWAY DR",
"city": "LA MESA",
"state": "CA",
"postal_code": "919422104",
"telephone_number": "800-528-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENN",
"first_name": "MARK",
"middle_name": "W",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-26",
"last_updated": "2015-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036085370",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "G131027",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.