Individual provider Active NPI

Mark Sadao Akizuki

  • Physical Therapist
  • Los Gatos, CA
National Provider Identifier
1194244756
Registry record updated Jan 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT293556 Issued in CA
Practice address
291 E Main St Ste E
Los Gatos, CA 95030-6137
Phone
(408) 354-2223
Fax
(408) 979-2301
NPI assigned
Sep 14, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT293556 CA Primary

Addresses

Primary practice location

291 E Main St Ste E
Los Gatos, CA 95030-6137

Mailing address

291 E Main St Ste E
Los Gatos, CA 95030-6137
Phone (408) 354-2223

Other practice location 1

68 Willow Rd
Menlo Park, CA 94025-3653
Phone (866) 839-6979

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE) The Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171017002176 CA Practitioner - Physical Therapist in Private Practice 9234405325 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT293556CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Permanente Medical Group Inc CurrentSince Dec 23, 2020 Accepting new patients
California Luna Care Physical Therapy PC Physical Therapist CurrentSince Oct 2, 2019 Accepting new patients
Permanente Medical Group, Inc CurrentSince Dec 23, 2020 Accepting new patients
Permanente Medical Group Inc Current Accepting new patients

Locations

750 Auburn Ravine Rd
Auburn, CA 95603
Phone (530) 823-6131

39400 Paseo Padre Pkwy
Fremont, CA 94538
Phone (510) 248-3000

4753 W Shaw Ave
Ste 101
Fresno, CA 93722
Phone (559) 277-8738

900 N Douty St
Hanford, CA 93230
Phone (559) 587-9014

68 Willow Rd
Menlo Park, CA 94025
Phone (650) 691-8630

101 Monroe St
Petaluma, CA 94954
Phone (707) 763-4109

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

930 W Main St
Ripon, CA 95366
Phone (209) 599-4221

501 J St
Sacramento, CA 95814
Phone (916) 497-3000

2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000

710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400

5615 Scotts Valley Dr
Scotts Valley, CA 95066
Phone (831) 430-2700

7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000

975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000

320 N Crawford St
Willows, CA 95988
Phone (530) 934-2834

Organizations & group practices 4

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": "1505347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641254400000",
    "number": "1194244756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "291 E MAIN ST STE E",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950306137",
            "telephone_number": "408-354-2223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "291 E MAIN ST STE E",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950306137",
            "telephone_number": "408-354-2223",
            "fax_number": "408-979-2301"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "68 Willow Rd",
            "address_purpose": "LOCATION",
            "city": "Menlo Park",
            "state": "CA",
            "postal_code": "940253653",
            "country_code": "US",
            "telephone_number": "866-839-6979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AKIZUKI",
        "first_name": "MARK",
        "middle_name": "SADAO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-14",
        "last_updated": "2022-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT293556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "39400 Paseo Padre Pkwy",
            "city": "Fremont",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945382310",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Gatos, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.