Active NPI
Mark Carlton Rounsaville, MD
- Radiation Oncology Physician
- Nicasio, CA
National Provider Identifier
1033100284
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiation Oncology Physician
- License
- A39060
- Practice address
- 45 Los Pinos
Nicasio, CA 94946 - Phone
- (415) 662-2669
- Fax
- (415) 662-2669
- NPI assigned
- Nov 4, 2005
- Last updated
- May 17, 2022
- 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 |
|---|---|---|---|---|
| Radiation Oncology Physician | 2085R0001X | A39060 | CA | Primary |
Addresses
Primary practice location
45 Los Pinos
Nicasio, CA 94946
Mailing address
45 Los Pinos
Nicasio, CA 94946
Phone (415) 662-2669
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A390600 | Medicaid | CA | |
| 00A390600 | Other | CA | BLUE SHIELD |
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 |
|---|---|---|---|
| A39060 | CA | MD | Radiation Oncology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131062400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652745600000",
"number": "1033100284",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "45 LOS PINOS",
"city": "NICASIO",
"state": "CA",
"postal_code": "94946",
"telephone_number": "415-662-2669",
"fax_number": "415-662-2669"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "45 LOS PINOS",
"city": "NICASIO",
"state": "CA",
"postal_code": "94946",
"telephone_number": "415-662-2669",
"fax_number": "415-662-2669"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROUNSAVILLE",
"first_name": "MARK",
"middle_name": "CARLTON",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-04",
"last_updated": "2022-05-17",
"certification_date": "2022-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0001X",
"taxonomy_group": "",
"desc": "Radiology, Radiation Oncology",
"state": "CA",
"license": "A39060",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A390600",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "00A390600",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Nicasio, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.