Mark D. Hendricks, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

G62541 Issued in CA

Practice address

2525 Camino del Rio S Ste 165
San Diego, CA 92108-3742

Phone

(619) 543-9655

Fax

(619) 543-9658

NPI assigned

Dec 22, 2005

Last updated

Aug 3, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• M. Dalia Strauser, MD

  • Internal Medicine Physician
  • San Diego, CA
  • NPI 1376539403
  NPD (past)
• Michael J. Sullivan MD

  • Internal Medicine Physician
  • San Diego, CA
  • NPI 1295736155
  NPD (past)

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

{
    "created_epoch": "1135209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659484800000",
    "number": "1164409983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 CAMINO DEL RIO S STE 165",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083742",
            "telephone_number": "619-543-9655",
            "fax_number": "619-543-9658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 CAMINO DEL RIO S STE 165",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083742",
            "telephone_number": "619-543-9655",
            "fax_number": "619-543-9658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRICKS",
        "first_name": "MARK",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-22",
        "last_updated": "2022-08-03",
        "certification_date": "2022-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G62541",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Rachel Hendon
• Daniel Brian Hendrey, M.D.
• James Hendricks, D.O.
• Jennifer Lynn Hendricks, PHARMD
• Korey Solomon Hendricks, MA, LPCC
• Michael Ryan Hendricks II
• Michael Ryan Hendricks, IDC
• Myles Hendricks
• P. Lance Hendricks, M.D.
• Theresa Hendricks, PT

• Internal Medicine Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.