Individual provider Active NPI

Mark A Shulman, DPT

  • Physical Therapist
  • San Diego, CA
National Provider Identifier
1477865848
Registry record updated Oct 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
36879 Issued in CA
Practice address
1601 Kettner Blvd
Suite 11
San Diego, CA 92101-2500
Phone
(619) 544-1055
Fax
(619) 544-1056
NPI assigned
Jul 13, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2019

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 36879 CA Primary

Addresses

Primary practice location

1601 Kettner Blvd
Suite 11
San Diego, CA 92101-2500

Mailing address

1601 Kettner Blvd
Unit 11
San Diego, CA 92101-2539
Phone (619) 544-1055

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101201000664 CA Practitioner - Physical Therapist in Private Practice 1759577828 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physical Therapy Effect PCGroup PAC ID 4385870062, 8 clinicians

Practice addresses (Care Compare)

1601 Kettner Blvd
Unit 11
San Diego, CA 92101-2539
Phone (619) 544-1055

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Physical Therapy Effect PC Physical Therapist CurrentSince Jul 30, 2013 Accepting new patients
Adams Physical Therapy Physical Therapist PastSince Aug 10, 2013 Accepting new patients

Organizations & group practices 2

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": "1278979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572480000000",
    "number": "1477865848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 KETTNER BLVD",
            "address_2": "UNIT 11",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921012539",
            "telephone_number": "619-544-1055",
            "fax_number": "619-544-1056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 KETTNER BLVD",
            "address_2": "SUITE 11",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921012500",
            "telephone_number": "619-544-1055",
            "fax_number": "619-544-1056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHULMAN",
        "first_name": "MARK",
        "middle_name": "A",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-13",
        "last_updated": "2019-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "36879",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.