Individual provider Active NPI

Mark Cianciola, MD

  • Family Medicine Physician
  • Rancho Santa Margarita, CA
National Provider Identifier
1750371035
Registry record updated Mar 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G67328 Issued in CA
Practice address
29472 Avenida de Las Bandera
Rancho Santa Margarita, CA 92688-2651
Phone
(949) 459-9968
Fax
(949) 766-2565
NPI assigned
Oct 26, 2005
Last updated
Mar 5, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X G67328 CA Primary

Addresses

Primary practice location

29472 Avenida de Las Bandera
Rancho Santa Margarita, CA 92688-2651

Mailing address

29472 Avenida de Las Bandera
Rancho Santa Margarita, CA 92688-2651
Phone (949) 459-9968

Other identifiers 1

IdentifierTypeStateIssuer
00G673280MedicaidCA

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
I20100222000326 CA Practitioner - Family Practice 2668516113 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Boston University School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Memorialcare Medical FoundationGroup PAC ID 8729277314, 555 clinicians

Practice addresses (Care Compare)

29472 Avenida de Las Bandera
Rancho Santa Margarita, CA 92688-2651
Phone (949) 459-9968

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G67328CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorialcare Medical Foundation Family Medicine CurrentSince Feb 1, 2011 Accepting new patients
Mission Hospital Regional Medical Center Past Accepting new patients
Bristol Park Medical Group, Inc Family Medicine Past Accepting new patients
Saddleback Memorial Medical Center Past Accepting new patients
Long Beach Memorial Medical Past Accepting new patients
Long Beach Memorial Medical Past Accepting new patients
Orange Coast Memorial Medical Center Past Accepting new patients
Children's Hospital at Mission Past Accepting new patients
Children's Hospital of Orange County Past Accepting new patients

Locations

722 Baker St
Costa Mesa, CA 92626
Phone (714) 557-6300

17360 Brookhurst St
Fountain Vly, CA 92708
Phone (657) 241-3592

29472 Avenida de las Bandera
Rcho Sta Marg, CA 92688
Phone (949) 459-9968

2742 Dow Ave
Tustin, CA 92780
Phone (714) 665-1600

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: mcianciola194067@direct.memorialcare.org

Organizations & group practices 9

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.

Hospital & facility affiliations 1

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": "1130284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583366400000",
    "number": "1750371035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29472 AVENIDA DE LAS BANDERA",
            "city": "RANCHO SANTA MARGARITA",
            "state": "CA",
            "postal_code": "926882651",
            "telephone_number": "949-459-9968",
            "fax_number": "949-766-2565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29472 AVENIDA DE LAS BANDERA",
            "city": "RANCHO SANTA MARGARITA",
            "state": "CA",
            "postal_code": "926882651",
            "telephone_number": "949-459-9968",
            "fax_number": "949-766-2565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CIANCIOLA",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-26",
        "last_updated": "2020-03-05",
        "certification_date": "2020-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G67328",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G673280",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Santa Margarita, CA

Sources for this page

Verify at the official NPI Registry.