Individual provider Active NPI

Jun Ma, M.D.

  • Hospitalist Physician
  • Woodland Hills, CA
National Provider Identifier
1861752321
Registry record updated Nov 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
A128690 Issued in CA
Practice address
5601 De Soto Ave
Department of Internal Medicine
Woodland Hills, CA 91367-6701
Phone
(818) 719-2000
Fax
(818) 719-2000
NPI assigned
May 17, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X A128690 CA Primary

Addresses

Primary practice location

5601 De Soto Ave
Department of Internal Medicine
Woodland Hills, CA 91367-6701

Mailing address

393 E Walnut St
PHR Group Provider Enrollment Unit 3Rd FL
Pasadena, CA 91188-0001
Phone (877) 608-0044

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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
I20151016002306 CA Practitioner - HospitalistPractitioner - Internal Medicine 4385953165 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Wayne State University School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

25821 Vermont Ave
Harbor City, CA 90710-3518
Phone (310) 325-5111

25825 Vermont Ave
Harbor City, CA 90710-3518
Phone (310) 325-5111

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A128690CAMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Aug 25, 2015 Accepting new patients
Southern California Permanente Medical Group CurrentSince Aug 25, 2015 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients

Locations

25825 Vermont Ave
Harbor City, CA 90710
Phone (310) 325-5111

393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914

888 S Hill Rd
Ventura, CA 93003
Phone (805) 477-6400

5601 De Soto Ave
Woodland Hls, CA 91367
Phone (818) 719-2000

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 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": "1337212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638144000000",
    "number": "1861752321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "393 E WALNUT ST",
            "address_2": "PHR GROUP PROVIDER ENROLLMENT UNIT 3RD FL",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911880001",
            "telephone_number": "877-608-0044",
            "fax_number": "877-514-0903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5601 DE SOTO AVE",
            "address_2": "DEPARTMENT OF INTERNAL MEDICINE",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913676701",
            "telephone_number": "818-719-2000",
            "fax_number": "818-719-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MA",
        "first_name": "JUN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-17",
        "last_updated": "2021-11-29",
        "certification_date": "2020-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CA",
            "license": "A128690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "25825 Vermont Ave",
            "city": "Harbor City",
            "state": "CA",
            "country_code": "US",
            "postal_code": "907103518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Woodland Hills, CA

Sources for this page

Verify at the official NPI Registry.