Active NPI
Mark R Susskind, MD
- Urology Physician
- Fairfield, CA
National Provider Identifier
1003996950
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- G63205
- Practice address
- 1234 Empire St
Fairfield, CA 94533-5711 - Phone
- (707) 426-3911
- Fax
- (707) 434-2043
- NPI assigned
- Oct 16, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | G63205 | CA | Primary |
Addresses
Primary practice location
1234 Empire St
Fairfield, CA 94533-5711
Mailing address
10470 Old Placerville Rd
#100
Sacramento, CA 95827-2539
Phone (866) 681-0736
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G632050 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G63205 | CA | MD | Urology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432598400000",
"number": "1003996950",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10470 OLD PLACERVILLE RD",
"address_2": "#100",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958272539",
"telephone_number": "866-681-0736"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1234 EMPIRE ST",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945335711",
"telephone_number": "707-426-3911",
"fax_number": "707-434-2043"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUSSKIND",
"first_name": "MARK",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-16",
"last_updated": "2015-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "CA",
"license": "G63205",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G632050",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CA
- Mariejoy B Supapo, BSN
- Super Care, LLC
- Superior Court of California County of Solano
- Surgical Imaging Services Inc.
- Ronald Susa, PHARMD
- Lynda Sussman, PHD CLINICAL PSYCHOL
- Sutter Fairfield Surgery Center, LLC
- Sutter Regional Medical Foundation
- Sutter Regional Medical Foundation
- Sutter Regional Medical Foundation
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.