Mark Newman Pederson, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

G33814 Issued in CA

Practice address

1783 El Camino Real
Burlingame, CA 94010-3205

Phone

(650) 696-5515

NPI assigned

Jun 16, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Specialty

Diagnostic Radiology

Education

University of Iowa, RJ & L Carver College of Medicine, 1972

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

County of San MateoGroup PAC ID 9032023171, 316 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• San Mateo Medical Center Hospital, San Mateo, CA, CCN 050113

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations (25 of 26)

Interoperability endpoints

• Direct secure messaging: mpederson21509@smch.direct-ci.com

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.

• County of San Mateo

  • Multi-Specialty Clinic/Center
  • San Mateo, CA
  • NPI 1679642326
  Medicare reassignment Care Compare group NPD
• California Advanced Imaging Medical Associates Inc

  • Diagnostic Radiology Physician
  • San Francisco, CA
  • NPI 1881646909
  Medicare reassignment NPD
• Sutter Bay Medical Foundation

  • Multi-Specialty Clinic/Center
  • Palo Alto, CA
  • NPI 1013950807
  Medicare reassignment NPD
• County of San Mateo

  • Public Health or Welfare Agency
  • San Mateo, CA
  • NPI 1306907928
  NPD
• County of San Mateo

  • Multi-Specialty Clinic/Center
  • San Mateo, CA
  • NPI 1831268580
  NPD
• County of San Mateo

  • Multi-Specialty Clinic/Center
  • San Mateo, CA
  • NPI 1841369592
  NPD
• Sutter Bay Medical Foundation

  • Multi-Specialty Clinic/Center
  • Orinda, CA
  • NPI 1366898538

  Diagnostic Radiology

  NPD
• Sutter Bay Medical Foundation

  • Clinical Medical Laboratory
  • Santa Clara, CA
  • NPI 1669287033
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• County of San Mateo

  • General Acute Care Hospital
  • San Mateo, CA
  • NPI 1003985755
  Care Compare affiliation
• County of San Mateo

  • Federally Qualified Health Center (FQHC)
  • Daly City, CA
  • NPI 1023196011

  Hospital

  Care Compare affiliation
• County of San Mateo

  • Federally Qualified Health Center (FQHC)
  • Daly City, CA
  • NPI 1265522619

  Hospital

  Care Compare affiliation
• County of San Mateo

  • General Acute Care Hospital
  • San Mateo, CA
  • NPI 1386713030
  Care Compare affiliation
• County of San Mateo

  • Federally Qualified Health Center (FQHC)
  • Redwood City, CA
  • NPI 1386728533

  Hospital

  Care Compare affiliation
• County of San Mateo

  • Federally Qualified Health Center (FQHC)
  • Redwood City, CA
  • NPI 1568540557

  Hospital

  Care Compare affiliation
• County of San Mateo

  • Federally Qualified Health Center (FQHC)
  • South San Francisco, CA
  • NPI 1750460671

  Hospital

  Care Compare affiliation
• County of San Mateo

  • Federally Qualified Health Center (FQHC)
  • Half Moon Bay, CA
  • NPI 1841379765

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233878400000",
    "number": "1063457034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 6102",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949486102",
            "telephone_number": "415-884-3418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1783 EL CAMINO REAL",
            "city": "BURLINGAME",
            "state": "CA",
            "postal_code": "940103205",
            "telephone_number": "650-696-5515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSON",
        "first_name": "MARK",
        "middle_name": "NEWMAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2009-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "G33814",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G338140",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "300121863",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marc Patricio
• Pauline Chau Nutrition, LLC
• Maria Pavlova, RD
• Tom Peabody, PH.D.
• Pear Holdings, LLC
• Jessie Peng, NP-C
• Peninsula Allergy Associates, a Medical Group Inc.
• Peninsula Child and Family Therapy Inc
• Peninsula Dermatology Medical Group Inc
• Peninsula Endoscopy Center LLC

• Diagnostic Radiology Physician in Burlingame, CA
• Providers in Burlingame, CA by specialty
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.