Individual provider Active NPI

Marcus Hicks

  • Peer Specialist
  • Norwalk, CA
National Provider Identifier
1780933010
Registry record updated Jan 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Peer SpecialistTaxonomy code 175T00000X
License
MPSS-YTWHRO Issued in CA
Practice address
12501 Imperial Hwy
Norwalk, CA 90650-3179
Phone
(562) 864-7821
NPI assigned
Aug 31, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X
Community Health Worker 172V00000X
Peer Specialist 175T00000X MPSS-YTWHRO CA Primary

Addresses

Primary practice location

12501 Imperial Hwy
Norwalk, CA 90650-3179

Mailing address

12501 Imperial Hwy
Norwalk, CA 90650-3179
Phone (562) 864-7821

Other practice location 1

12440 Firestone Blvd
Norwalk, CA 90650-4328
Phone (562) 929-6688

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
MPSS-YTWHROCAMDPeer Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Telecare Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1346371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736812800000",
    "number": "1780933010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12501 IMPERIAL HWY",
            "city": "NORWALK",
            "state": "CA",
            "postal_code": "906503179",
            "telephone_number": "562-864-7821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12501 IMPERIAL HWY",
            "city": "NORWALK",
            "state": "CA",
            "postal_code": "906503179",
            "telephone_number": "562-864-7821"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12440 Firestone Blvd",
            "address_purpose": "LOCATION",
            "city": "Norwalk",
            "state": "CA",
            "postal_code": "906504328",
            "country_code": "US",
            "telephone_number": "562-929-6688",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HICKS",
        "first_name": "MARCUS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-31",
        "last_updated": "2025-01-14",
        "certification_date": "2025-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "CA",
            "license": "MPSS-YTWHRO",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norwalk, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.