NPIMap

Individual provider Active NPI

Marcil M Mamita, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Torrance, CA
National Provider Identifier
1962412718
Registry record updated Mar 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
A72411 Issued in CA
Practice address
3655 Lomita Blvd Ste 418
Torrance, CA 90505-1934
Phone
(310) 530-6900
Fax
(310) 530-6902
NPI assigned
Aug 8, 2006
Last updated
Mar 8, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 8, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X A72411 CA Primary

Addresses

Primary practice location

3655 Lomita Blvd Ste 418
Torrance, CA 90505-1934

Mailing address

941 Stanford St
Santa Monica, CA 90403-2223
Phone (310) 490-6954

Other identifiers 1

IdentifierTypeStateIssuer
0072411MedicaidCA

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
I20050331000508 CA Practitioner - Internal MedicinePractitioner - Geriatric Medicine 5698722858 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

3655 Lomita Blvd
Suite 418
Torrance, CA 90505-1934
Phone (310) 530-6900

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Removal of tissue14
Removal of nail tissue60
Removal or shaving of skin growth23

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A72411CAMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Marcil M. Mamita, M.D., a Medical Corporation Geriatric Medicine CurrentSince Jan 1, 2010 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Healthcare Partners Affiliates Medical Group Past Accepting new patients
Torrance Memorial Medical Center Past Accepting new patients
Providence Health System Southern California Past Accepting new patients

Locations

1403 Lomita Blvd
Ste 303A
Harbor City, CA 90710
Phone (818) 691-1300

3655 Lomita Blvd
Ste 418
Torrance, CA 90505
Phone (310) 378-9002

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552003200000",
    "number": "1962412718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "941 STANFORD ST",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904032223",
            "telephone_number": "310-490-6954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3655 LOMITA BLVD STE 418",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905051934",
            "telephone_number": "310-530-6900",
            "fax_number": "310-530-6902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAMITA",
        "first_name": "MARCIL",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2019-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "A72411",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0072411",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Torrance, CA

Sources for this page

Verify at the official NPI Registry.