NPIMap

Individual provider Active NPI

Marvin Phillip Masada, MD.

  • Family Medicine Physician
  • San Jose, CA
National Provider Identifier
1891851929
Registry record updated May 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A062906 Issued in CA
Practice address
1569 Lexann Ave
Suite 128
San Jose, CA 95121-1794
Phone
(408) 274-1654
Fax
(408) 274-8021
NPI assigned
Jan 1, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 20, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A062906 CA Primary

Addresses

Primary practice location

1569 Lexann Ave
Suite 128
San Jose, CA 95121-1794

Mailing address

1569 Lexann Ave
Suite 128
San Jose, CA 95121-1794
Phone (408) 274-1654

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
I20090127000727 CA Practitioner - Family Practice 1951461748 Practice locations: San Jose, CA

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Wisconsin, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1569 Lexann Ave
San Jose, CA 95121-1794
Phone (408) 274-1654

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
22.9 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
76.33

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
62906CAMDClinical Social Worker
A062906CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
With Grace Ministries Inc. Family Medicine CurrentSince Aug 18, 2014 Accepting new patients
Khae Saephanh, D.O., Inc Family Medicine Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: tina_p@efmc.gwaydirect.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
With Grace Hospice and Palliative CareSan Jose, CA, CCN 751644 Hospice 5% Or Greater Direct Ownership Interest (50%)
W-2 Managing Employee		 Aug 18, 2014
Aug 18, 2014

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • With Grace Ministries Inc.

    dba With Grace Hospice and Palliative Care

    • Community Based Hospice Care Agency
    • San Jose, CA
    • NPI 1952704645

    5% Or Greater Direct Ownership Interest, W-2 Managing Employee

    CMS ownership

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 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": "1167609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432080000000",
    "number": "1891851929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1569 LEXANN AVE",
            "address_2": "SUITE 128",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951211794",
            "telephone_number": "408-274-1654",
            "fax_number": "408-274-8021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1569 LEXANN AVE",
            "address_2": "SUITE 128",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951211794",
            "telephone_number": "408-274-1654",
            "fax_number": "408-274-8021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASADA",
        "first_name": "MARVIN",
        "middle_name": "PHILLIP",
        "credential": "MD.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-01",
        "last_updated": "2015-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A062906",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.