Individual provider Active NPI

Mark Benton Lewis

  • Surgery Physician
  • Los Angeles, CA
National Provider Identifier
1740861590
Registry record updated Jan 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
A188704 Issued in CA
Practice address
1200 N State St
Clinic Tower, Suite A7D
Los Angeles, CA 90033-1029
Phone
(323) 442-7824
Fax
(323) 442-8009
NPI assigned
Apr 14, 2021
Last updated
Jan 15, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X A188704 CA Primary

Addresses

Primary practice location

1200 N State St
Clinic Tower, Suite A7D
Los Angeles, CA 90033-1029

Mailing address

1200 N State St
Clinic Tower, Suite A7D
Los Angeles, CA 90033-1029
Phone (323) 442-7824

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
I20241024002427 CA Practitioner - General Surgery 2264804335 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Mississippi School of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Izuchukwu Okpara MD IncGroup PAC ID 1052698966, 45 clinicians

Practice addresses (Care Compare)

28212 Kelly Johnson Pkwy
Suite 200
Valencia, CA 91355-5090
Phone (213) 228-3538

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue27
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A188704CAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Izuchukwu Okpara MD Inc Surgery CurrentSince Oct 14, 2024 Accepting new patients

Locations

5430 Arlington Ave
Riverside, CA 92504
Phone (714) 458-4617

25044 Peachland Ave
Ste 110
Santa Clarita, CA 91321

28212 Kelly Johnson Pkwy
Ste 200
Valencia, CA 91355
Phone (661) 388-5945

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1618358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736899200000",
    "number": "1740861590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 N STATE ST",
            "address_2": "CLINIC TOWER, SUITE A7D",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900331029",
            "telephone_number": "323-442-7824",
            "fax_number": "323-442-8009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 N STATE ST",
            "address_2": "CLINIC TOWER, SUITE A7D",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900331029",
            "telephone_number": "323-442-7824",
            "fax_number": "323-442-8009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "MARK",
        "middle_name": "BENTON",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-14",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A188704",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.