Individual provider Active NPI

Connor Anthony Berk, LMFT

  • Marriage & Family Therapist
  • San Marcos, CA
National Provider Identifier
1104697796
Registry record updated Sep 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
156236 Issued in CA
Practice address
300 Rancheros Dr Ste 130
San Marcos, CA 92069-2968
Phone
(858) 279-1223
NPI assigned
Jan 11, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 156236 CA Primary

Addresses

Primary practice location

300 Rancheros Dr Ste 130
San Marcos, CA 92069-2968

Mailing address

300 Rancheros Dr Ste 130
San Marcos, CA 92069-2968
Phone (858) 279-1223

Other practice location 1

17140 Bernardo Center Dr
San Diego, CA 92128-2093
Phone (833) 579-4848

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251003003829 CA Practitioner - Marriage and Family Therapist 9436655768 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pacific Coast Psychiatric Associates IncGroup PAC ID 2567469174, 637 clinicians

Practice addresses (Care Compare)

300 Rancheros Dr
Suite 130
San Marcos, CA 92069-2968
Phone (858) 279-1223

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
156236CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Coast Psychiatric Associates Inc CurrentSince Sep 19, 2025 Accepting new patients

Locations

8881 Fletcher Pkwy
Ste 350
La Mesa, CA 91942
Phone (619) 465-9792

300 Rancheros Dr
Ste 130
San Marcos, CA 92069

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1704931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758240000000",
    "number": "1104697796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 RANCHEROS DR STE 130",
            "city": "SAN MARCOS",
            "state": "CA",
            "postal_code": "920692968",
            "telephone_number": "858-279-1223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 RANCHEROS DR STE 130",
            "city": "SAN MARCOS",
            "state": "CA",
            "postal_code": "920692968",
            "telephone_number": "858-279-1223"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17140 Bernardo Center Dr",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921282093",
            "country_code": "US",
            "telephone_number": "833-579-4848",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERK",
        "first_name": "CONNOR",
        "middle_name": "ANTHONY",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-01-11",
        "last_updated": "2025-09-19",
        "certification_date": "2025-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "156236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Marcos, CA

Sources for this page

Verify at the official NPI Registry.