NPIMap

Individual provider Active NPI

Mark Cubberly, MD

  • Orthopaedic Surgery Physician
  • Tustin, CA
National Provider Identifier
1760923114
Registry record updated Nov 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
A158506 Issued in CA
Practice address
14642 Newport Ave Ste 105
Tustin, CA 92780-6058
Phone
(949) 688-0958
NPI assigned
Mar 18, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Orthopaedic Surgery Physician 207X00000X A158506 CA Primary

Addresses

Primary practice location

14642 Newport Ave Ste 105
Tustin, CA 92780-6058

Mailing address

14642 Newport Ave Ste 105
Tustin, CA 92780-6058

Other practice location 1

11180 Warner Ave Ste 161
Fountain Valley, CA 92708-7515
Phone (714) 456-7890

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230609001407 CA Practitioner - Orthopedic Surgery 2668705617 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
University of Virginia School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Richard Lin DO IncGroup PAC ID 1456761915, 6 clinicians

Practice addresses (Care Compare)

14642 Newport Ave
Suite 105
Tustin, CA 92780-6058
Phone (949) 688-0958

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement1-10
Knee replacement1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A158506CAMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Richard Lin DO Inc Orthopaedic Surgery CurrentSince May 1, 2023 Accepting new patients
Alta Newport Hospital, LLC Past Accepting new patients
Alta Los Angeles Hospital, Inc Past Accepting new patients

Locations

11180 Warner Ave
Ste 161
Fountain Vly, CA 92708
Phone (714) 556-8320

420 E 3rd St
Ste 910
Los Angeles, CA 90013
Phone (213) 922-8144

14642 Newport Ave
Ste 105
Tustin, CA 92780
Phone (310) 208-6104

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: mcubberly531995@direct.memorialcare.org

Organizations & group practices 3

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.

Hospital & facility affiliations 5

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": "1489795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699401600000",
    "number": "1760923114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14642 NEWPORT AVE STE 105",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927806058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14642 NEWPORT AVE STE 105",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927806058",
            "telephone_number": "949-688-0958"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11180 Warner Ave Ste 161",
            "address_purpose": "LOCATION",
            "city": "Fountain Valley",
            "state": "CA",
            "postal_code": "927087515",
            "country_code": "US",
            "telephone_number": "714-456-7890",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CUBBERLY",
        "first_name": "MARK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-18",
        "last_updated": "2023-11-08",
        "certification_date": "2023-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "A158506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

Verify at the official NPI Registry.