Active NPI
Ian W Marks, PAC
- Physician Assistant
- Glendale, CA
National Provider Identifier
1760506869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA51543
- Practice address
- 544 N Glendale Ave
Glendale, CA 91206-3311 - Phone
- (818) 241-4331
- NPI assigned
- Mar 16, 2007
- Last updated
- Jul 22, 2014
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0110001200 | VA | |
| Physician Assistant | 363A00000X | PA51543 | CA | Primary |
| Surgical Physician Assistant | 363AS0400X | 0110001200 | VA |
Addresses
Primary practice location
544 N Glendale Ave
Glendale, CA 91206-3311
Mailing address
544 N Glendale Ave
Glendale, CA 91206-3311
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA51543 | CA | MD | Physician Assistant |
| 0110001200 | VA | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Washington County Emergency Medicine Physicians, LLC | Past | Accepting new patients | |
| Lima Memorial Joint Operating Company | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Lima Memorial Health System
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
-
- Emergency Care Clinic/Center
- Hagerstown, MD
- NPI 1205826724
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405987200000",
"number": "1760506869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "544 N GLENDALE AVE",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912063311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "544 N GLENDALE AVE",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912063311",
"telephone_number": "818-241-4331"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARKS",
"first_name": "IAN",
"middle_name": "W",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-16",
"last_updated": "2014-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "VA",
"license": "0110001200",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA51543",
"primary": true
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "VA",
"license": "0110001200",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.