NPIMap

Individual provider Active NPI

Bruce M Stark, M.D.

  • Internal Medicine Physician
  • Burbank, CA
National Provider Identifier
1902801301
Registry record updated Oct 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G72204 Issued in CA
Practice address
201 S Buena Vista St
Suite 300
Burbank, CA 91505-4569
Phone
(818) 842-7145
Fax
(818) 842-8202
NPI assigned
Jun 14, 2005
Reactivated
Apr 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X G72204 CA Primary
Addiction Medicine (Internal Medicine) Physician 207RA0401X G72204 CA

Addresses

Primary practice location

201 S Buena Vista St
Suite 300
Burbank, CA 91505-4569

Mailing address

201 S Buena Vista St
Suite 300
Burbank, CA 91505-4569
Phone (818) 842-7145

Other identifiers 1

IdentifierTypeStateIssuer
00G722040MedicaidCA

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
I20040317000318 CA Practitioner - Internal Medicine 4183514854 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Un of California, Irvine, College of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Premiere Medical Center of Burbank, IncGroup PAC ID 4688709744, 5 clinicians

Practice addresses (Care Compare)

4418 Vineland Ave
Suite 102
Toluca Lake, CA 91602-3457
Phone (818) 842-7145

Hospital & facility affiliations

  • Preferred Choice Home Health Care, Inc Home health agency, Reseda, CA, CCN 559037
  • Pluto Home Health Care, Inc. Home health agency, North Hollywood, CA, CCN 757909
  • Providence Saint Joseph Medical Ctr Hospital, Burbank, CA, CCN 050235

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G72204CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Premiere Medical Center of Burbank, Inc. Internal Medicine CurrentSince Jan 26, 2010 Accepting new patients
Miracles in Action LLC CurrentSince Aug 12, 2023 Accepting new patients
Burbank East Valley Medical Group Internal Medicine Past Accepting new patients
Lakeside Medical Organization, a Medical Group Inc. Internal Medicine Past Accepting new patients
Valley Healthcare Med GRP Internal Medicine Past Accepting new patients

Locations

9241 Reseda Blvd
Ste 200
Northridge, CA 91324
Phone (818) 429-9103

4418 Vineland Ave
Ste 102
Toluca Lake, CA 91602
Phone (818) 842-7145

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 5

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 3

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": "1118707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697155200000",
    "number": "1902801301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 S BUENA VISTA ST",
            "address_2": "SUITE 300",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915054569",
            "telephone_number": "818-842-7145",
            "fax_number": "818-842-8202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 S BUENA VISTA ST",
            "address_2": "SUITE 300",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915054569",
            "telephone_number": "818-842-7145",
            "fax_number": "818-842-8202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARK",
        "first_name": "BRUCE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-14",
        "last_updated": "2023-10-13",
        "certification_date": "2023-10-13",
        "deactivation_date": "2006-03-21",
        "reactivation_date": "2006-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G72204",
            "primary": true
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "CA",
            "license": "G72204",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G722040",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burbank, CA

Sources for this page

Verify at the official NPI Registry.