Individual provider Active NPI

Marcel O. Ponton, PH.D.

  • Clinical Psychologist
  • Los Angeles, CA
National Provider Identifier
1861595845
Registry record updated Aug 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY12133 Issued in CA
Practice address
760 Westwood PLZ RM 17-369
Los Angeles, CA 90095-2039
Phone
(310) 206-9326
Fax
(310) 206-1109
NPI assigned
Sep 6, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 8, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X PSY12133 CA
Clinical Psychologist 103TC0700X PSY12133 CA Primary

Addresses

Primary practice location

760 Westwood PLZ RM 17-369
Los Angeles, CA 90095-2039

Mailing address

5767 W Century Blvd Ste 400
Los Angeles, CA 90045-5631
Phone (310) 301-8707

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051019000596 CA Practitioner - Clinical Psychologist 8224928221 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
UC RegentsGroup PAC ID 0749180453, 148 clinicians

Practice addresses (Care Compare)

300 Medical PLZ
Suite 2200
Los Angeles, CA 90095-6968
Phone (310) 825-9989

Merit-based Incentive Payment System (MIPS)

Final score
88.32 of 100Reported as group
Quality
76.01
Promoting interoperability
100
Improvement activities
40
Cost
56.17

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12133CAMDAddiction (Substance Use Disorder) Counselor
PSY12133CAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
UC Regents Clinical CurrentSince Dec 1, 2020 Accepting new patients
County of Los Angeles CurrentSince Mar 1, 2016 Accepting new patients
County of Los Angeles CurrentSince Mar 1, 2016 Accepting new patients
UCLA Medical Group Past Accepting new patients

Locations

5767 W Century Blvd
Ste 400
Los Angeles, CA 90045
Phone (310) 301-5200

760 Westwood Plz
Rm 17369
Los Angeles, CA 90095
Phone (310) 206-9326

File 2939
Los Angeles, CA 90074
Phone (310) 794-6596

300 Medical Plz
Los Angeles, CA 90095
Phone (310) 206-8438

760 Westwood Plz
Ste 17369
Los Angeles, CA 90095
Phone (310) 794-6386

14445 Olive View Dr
Sylmar, CA 91342
Phone (881) 836-4303

14445 Olive View Dr
#2C155
Sylmar, CA 91342
Phone (818) 364-3001

1000 W Carson St
Torrance, CA 90502
Phone (310) 222-3501

Organizations & group practices 4

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": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723075200000",
    "number": "1861595845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD STE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455631",
            "telephone_number": "310-301-8707",
            "fax_number": "310-301-8752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "760 WESTWOOD PLZ RM 17-369",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900952039",
            "telephone_number": "310-206-9326",
            "fax_number": "310-206-1109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONTON",
        "first_name": "MARCEL",
        "middle_name": "O.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-06",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "PSY12133",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY12133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.