Jack Vanbezooyen

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

171751 Issued in CA

Practice address

240 Tamal Vista Blvd
Corte Madera, CA 94925-1132

Phone

(916) 969-7074

NPI assigned

Apr 5, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Jack Van Bezooyen Professional name

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

Locations

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.

• Bay Psychiatric Associates

  • Psychiatry Physician
  • Berkeley, CA
  • NPI 1427163229
  Medicare reassignment NPD
• City & County of San Francisco

  • Clinical Medical Laboratory
  • San Francisco, CA
  • NPI 1982737524
  Medicare reassignment NPD
• County of Marin

  • Community/Behavioral Health Agency
  • San Rafael, CA
  • NPI 1912116252
  Medicare reassignment NPD
• City and County of San Francisco

  • Methadone Clinic
  • San Francisco, CA
  • NPI 1578787925
  NPD
• County of Marin

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • San Rafael, CA
  • NPI 1326258856
  NPD

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

{
    "created_epoch": "1491350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653955200000",
    "number": "1346773504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 POTRERO AVE",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941103518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 TAMAL VISTA BLVD",
            "city": "CORTE MADERA",
            "state": "CA",
            "postal_code": "949251132",
            "telephone_number": "916-969-7074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANBEZOOYEN",
        "first_name": "JACK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-04-05",
        "last_updated": "2022-05-31",
        "certification_date": "2022-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "171751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACK",
            "last_name": "VAN BEZOOYEN",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Erica Ilana Trumbull, L.AC.
• Francisca Fernanda Turen Burgos, FNP-C
• Wilhelmina Turkovich, AMFT
• Skylar Ulrich, M.D.
• Christine Elizabeth Valdez, PH.D.
• Alissa C Vannet, PSYD
• Nicole Renee Vas, RD, CDE
• Elijah Verheyen
• Anna G Vishnyakova
• Katia Voicehowsky, R.D

• Psychiatry Physician in Corte Madera, CA
• Providers in Corte Madera, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 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.