Active NPI
Mark S. Reisman, MD
- Dermatology Physician
- Oakland, CA
National Provider Identifier
1124106919
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- G54329
- 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
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 |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G543290 | Medicaid | CA |
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
Enrollment records 1
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
Practice addresses (Care Compare)
490 Post St
Suite 320
San Francisco, CA 94102-1404
Phone (415) 781-1932
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
| Removal of skin lesions | 47 |
| Skin biopsy | 11 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G54329 | CA | MD | Dermatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| City & County of San Francisco | Current | Accepting new patients | |
| San Francisco Dermatology Inc | Dermatology | Current | Accepting new patients |
| City and County of San Francisco | Current | Accepting new patients | |
| County of San Mateo | Current | Accepting new patients | |
| City & County of San Francisco | Current | Accepting new patients | |
| County of San Mateo | Current | Accepting new patients | |
| County of San Mateo | Current | 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
- https://api.platform.athenahealth.com/1805/brand/2/csg/23/fhir/r4
- 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.
-
- Dermatology Physician
- San Francisco, CA
- NPI 1295927986
-
- Clinical Medical Laboratory
- San Francisco, CA
- NPI 1982737524
-
- Multi-Specialty Clinic/Center
- San Mateo, CA
- NPI 1679642326
-
- Multi-Specialty Clinic/Center
- San Mateo, CA
- NPI 1831268580
-
- Community Health/Public Health Clinical Nurse Specialist
- San Francisco, CA
- NPI 1609041060
-
- Methadone Clinic
- San Francisco, CA
- NPI 1578787925
-
- Community/Behavioral Health Agency
- Redwood City, CA
- NPI 1528432481
-
- Multi-Specialty Clinic/Center
- Oakland, CA
- NPI 1275002453
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2014; 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.