Individual provider Active NPI

Mark S. Reisman, MD

  • Dermatology Physician
  • Oakland, CA
National Provider Identifier
1124106919
Registry record updated Oct 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
G54329 Issued in CA
Practice address
275 W Macarthur
Oakland, CA 94611-5641
Phone
(510) 752-1000
NPI assigned
Nov 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X G54329 CA Primary

Addresses

Primary practice location

275 W Macarthur
Oakland, CA 94611-5641

Mailing address

275 W Macarthur
Oakland, CA 94611-5641
Phone (510) 752-1000

Other identifiers 1

IdentifierTypeStateIssuer
00G543290MedicaidCA

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110121000717 CA Practitioner - Dermatology 8729267877 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Medical College of Wisconsin, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
San Francisco Dermatology, Inc.Group PAC ID 3779661624, 2 clinicians

Practice addresses (Care Compare)

490 Post St
Suite 320
San Francisco, CA 94102-1404
Phone (415) 781-1932

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions47
Skin biopsy11

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G54329CAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
City & County of San Francisco CurrentSince Apr 1, 2020 Accepting new patients
San Francisco Dermatology Inc Dermatology CurrentSince Jan 1, 2016 Accepting new patients
City and County of San Francisco CurrentSince Apr 1, 2020 Accepting new patients
County of San Mateo CurrentSince Sep 15, 2017 Accepting new patients
City & County of San Francisco Current Accepting new patients
County of San Mateo CurrentSince Sep 15, 2017 Accepting new patients
County of San Mateo CurrentSince Sep 15, 2017 Accepting new patients
California Pacific Medical Group, Inc. Past Accepting new patients

Locations

490 Post St
Ste 320
San Francisco, CA 94102
Phone (415) 781-0551

1001 Potrero Ave
San Francisco, CA 94110
Phone (415) 206-2305

222 W 39th Ave
San Mateo, CA 94403
Phone (415) 573-2222

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1805/brand/2/csg/23/fhir/r4
  • Direct secure messaging: mark.reisman.1@1805.direct.athenahealth.com

Organizations & group practices 8

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": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413504000000",
    "number": "1124106919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 W MACARTHUR",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946115641",
            "telephone_number": "510-752-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 W MACARTHUR",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946115641",
            "telephone_number": "510-752-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REISMAN",
        "first_name": "MARK",
        "middle_name": "S.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2014-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "G54329",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G543290",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

Sources for this page

Verify at the official NPI Registry.