Individual provider Active NPI

Mazen Faris Odish, M.D.

  • Critical Care Medicine (Internal Medicine) Physician
  • San Diego, CA
National Provider Identifier
1992141428
Registry record updated Jul 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
License
A133179 Issued in CA
Practice address
200 W Arbor Dr
San Diego, CA 92103-9000
Phone
(800) 926-8273
NPI assigned
May 10, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X A133179 CA
Critical Care Medicine (Internal Medicine) Physician 207RC0200X A133179 CA Primary

Addresses

Primary practice location

200 W Arbor Dr
San Diego, CA 92103-9000

Mailing address

PO Box 232410
San Diego, CA 92193-2410

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
I20191120001459 CA Practitioner - Critical Care (Intensivists)Practitioner - Pulmonary Disease 7618269978 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: Pulmonary Disease
Education
University of Arizona College of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

200 W Arbor Dr
San Diego, CA 92103-9000
Phone (858) 249-6753

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.77 of 100Reported as group
Quality
84.13
Promoting interoperability
100
Improvement activities
40
Cost
73.88

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A133179CAMDCritical Care Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California CurrentSince Jun 28, 2020 Accepting new patients
Regents of the University of California Pulmonary Disease CurrentSince Jun 28, 2020 Accepting new patients
Chest Medicine and Critical Care Medical Group, Inc. Critical Care Medicine CurrentSince Aug 27, 2019 Accepting new patients
Emergency and Acute Care Medical Corporation CurrentSince Aug 27, 2019 Accepting new patients
Regents of the University of California Past Accepting new patients
Regents of the University of California Ucsd Head and Neck Surgery Past Accepting new patients

Locations

751 Medical Center Ct
Chula Vista, CA 91911
Phone (619) 482-3639

9300 Campus Point Dr
La Jolla, CA 92037
Phone (619) 957-7000

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754

4168 Front St
San Diego, CA 92103
Phone (619) 471-0420

4520 Executive Dr
San Diego, CA 92121
Phone (858) 249-1429

7901 Frost St
San Diego, CA 92123
Phone (619) 541-3400

3020 Childrens Way
San Diego, CA 92123
Phone (858) 966-5841

Organizations & group practices 6

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": "1368144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594598400000",
    "number": "1992141428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 232410",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921932410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W ARBOR DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921039000",
            "telephone_number": "800-926-8273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODISH",
        "first_name": "MAZEN",
        "middle_name": "FARIS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-10",
        "last_updated": "2020-07-13",
        "certification_date": "2020-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "CA",
            "license": "A133179",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "CA",
            "license": "A133179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.