MARK S PENNER (NPI# 1689602500) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689602500 |
| Entity Type | Individual |
| Full Name | MARK S PENNER |
| Credential | DO |
| Practice Address |
2105 Forest Ave San Jose CA 95128-1425 |
| Mailing Address |
Po Box 4419 Woodland Hills CA 91365-4419 |
| Practice Telephone | 4089472500 |
| Practice Fax Number | 8185872493 |
| Mailing Telephone | 8886203100 |
| Mailing Fax Number | 8185872493 |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | 20A8037 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00AX80370 | 05 | |
| CA | BLUE SHIELD | 020A80370 | 01 |
| CA | RAILROAD MEDICARE | P00273019 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821628157 | Mark Steven Penner | Pharmacist | 8989 Laureate Blvd, Orlando, FL 32827-7563 | 2020-01-26 |
| Street Address |
2105 FOREST AVE |
| City | SAN JOSE |
| State | CA |
| Zip Code | 95128-1425 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760475321 | Mrimaging of California, A Medical Corporation | Radiology | 2105 Forest Ave, Ste M, San Jose, CA 95128-1425 | 2005-08-29 |
| 1821602541 | Holly Maureen Milligan | Nurse Practitioner | 2105 Forest Ave, San Jose, CA 95128-1425 | 2020-09-01 |
| 1447724646 | County of Santa Clara | General Acute Care Hospital | 2105 Forest Ave, San Jose, CA 95128-1425 | 2019-01-22 |
| 1356813240 | Lyle Mroz | Pharmacist | 2105 Forest Ave, San Jose, CA 95128-1425 | 2018-12-18 |
| 1467921247 | O'connor Hospital | General Acute Care Hospital | 2105 Forest Ave, San Jose, CA 95128-1425 | 2018-11-21 |
| 1821565755 | Thuy Nhu Tran | Perfusionist | 2105 Forest Ave, San Jose, CA 95128-1425 | 2018-10-29 |
| 1306311576 | Emergency Physicians Associates San Jose PC | Emergency Medicine | 2105 Forest Ave, San Jose, CA 95128-1425 | 2018-10-03 |
| 1013492685 | Ryan Kar | Perfusionist | 2105 Forest Ave, San Jose, CA 95128-1471 | 2018-09-30 |
| 1205318128 | Pacific Neurophysiologists LLC | Electrodiagnostic Medicine | 2105 Forest Ave, San Jose, CA 95128-9512 | 2018-09-06 |
| 1952809808 | Anya Marie Milrod Holmquist | Nurse Practitioner | 2105 Forest Ave, San Jose, CA 95128-1425 | 2018-01-25 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982227138 | Ruth Larsen | Social Worker | 850 S. Bascom Avenue, Suite 280, San Jose, CA 95128 | 2020-05-22 |
| 1265067185 | Of Two Minds Psychotherapy | Marriage & Family Therapist | 190 S. Bascom Ave, Ste 130, San Jose, CA 95128 | 2020-03-11 |
| 1982244166 | Cindy Pantoja Escobar | Behavior Technician | 100 O'connor Drive, Suites 21, San Jose, CA 95128 | 2020-01-15 |
| 1104460591 | Katherine Alexandra Misogas | Pharmacist | 777 Turner Dr # 330, San Jose, CA 95128 | 2019-10-29 |
| 1942842216 | Jodie Pierce | Marriage & Family Therapist | 871 Enborg Lane, San Jose, CA 95128 | 2019-10-08 |
| 1003466434 | Dong Mi Cha | Pharmacist | 777 Turner Dr Ste 330, San Jose, CA 95128 | 2019-09-17 |
| 1114571759 | Sleep Well Acupuncture, Inc | Acupuncturist | 1361 S Winchester Blvd Suite 206, San Jose, CA 95128 | 2019-08-01 |
| 1083277677 | Wellocity, Inc | Health Educator | 334 Santana Row, 318, San Jose, CA 95128 | 2019-04-18 |
| 1518428812 | Alexander Diaz | Radiology | 75 South Bascom Ave, San Jose, CA 95128 | 2019-03-28 |
| 1720542103 | Nanci R Price Inc | Chiropractor | 100 O'connor Dr., Ste 27, San Jose, CA 95128 | 2019-01-30 |
| Find all providers in zip 95128 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104279348 | Jeff W Chiu | Emergency Medicine | 851 S Bacom Ave, San Jose, CA 95128 | 2016-07-22 |
| 1164838181 | James Saunders | Emergency Medicine | 124 Boston Ave, San Jose, CA 95128-1944 | 2014-07-10 |
| 1437563855 | Mark Douglas Zukunft | Emergency Medicine | 250 Hospital Pkwy Dept Of, San Jose, CA 95119 | 2014-06-13 |
| 1932467255 | Christopher Steven Campbell | Emergency Medicine | 1442 S Winchester Blvd # 117, San Jose, CA 95128-4330 | 2012-04-24 |
| 1952530537 | Steve Ming-cheng Sun | Emergency Medicine | 352 La Strada Dr, #12, San Jose, CA 95123-1001 | 2009-07-05 |
| 1881899805 | Peter Michael Intemann | Emergency Medicine | 751 South Bascom Avenue, Santa Clara Valley Medical Center, San Jose, CA 95128 | 2007-06-19 |
| 1053515833 | Howard Elliott Michaels | Emergency Medicine | 255 S Montgomery St, San Jose, CA 95110-2635 | 2007-06-13 |
| 1639256563 | David Douglas Hammons | Emergency Medicine | 55 E. Julian St, San Jose, CA 95112 | 2006-10-31 |
| 1437252301 | Vladimir G. Skorokhod | Emergency Medicine | 1375 Blossom Hill Rd, Suite 49, San Jose, CA 95118-3806 | 2006-09-06 |
| 1720028574 | California Emergency Physc Med Grp | Emergency Medicine | 219 North Jackson Avenue, San Jose, CA 95116 | 2006-06-08 |
| Find all providers in SAN JOSE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.