Individual provider Active NPI

Mary Lorene Minar, D.O.

  • Family Medicine Physician
  • Huntington Beach, CA
National Provider Identifier
1972653814
Registry record updated Nov 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20A5782 Issued in CA
Practice address
17762 Beach Blvd Ste 220
Huntington Beach, CA 92647-6860
Phone
(714) 848-0080
Fax
(714) 665-4679
NPI assigned
Jan 11, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2019

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 20A5782 CA Primary

Addresses

Primary practice location

17762 Beach Blvd Ste 220
Huntington Beach, CA 92647-6860

Mailing address

17762 Beach Blvd Ste 220
Huntington Beach, CA 92647-6860
Phone (714) 848-0080

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
I20191205001792 CA Practitioner - Family Practice 5496188419 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5782CAMDMental Health Counselor
20A5782CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorialcare Medical Foundation Family Medicine CurrentSince Dec 1, 2019 Accepting new patients
Pleiotropy, Inc. Family Medicine Past Accepting new patients
Beach Physicians Medical Group Inc Family Medicine PastSince Sep 18, 2002 Accepting new patients

Locations

722 Baker St
Costa Mesa, CA 92626
Phone (714) 557-6300

17360 Brookhurst St
Fountain Vly, CA 92708
Phone (657) 241-3592

17762 Beach Blvd
Ste 220
Huntington Beach, CA 92647
Phone (714) 848-0080

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572825600000",
    "number": "1972653814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17762 BEACH BLVD STE 220",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926476860",
            "telephone_number": "714-848-0080",
            "fax_number": "714-665-4679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17762 BEACH BLVD STE 220",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926476860",
            "telephone_number": "714-848-0080",
            "fax_number": "714-665-4679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINAR",
        "first_name": "MARY",
        "middle_name": "LORENE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-11",
        "last_updated": "2019-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A5782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntington Beach, CA

Sources for this page

Verify at the official NPI Registry.