Individual provider Active NPI

Mitchell Kauk, PT OCS

  • Orthopedic Physical Therapist
  • Petaluma, CA
National Provider Identifier
1548345390
Registry record updated May 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
PT10959 Issued in CA
Practice address
224A Weller St
Petaluma, CA 94952-3136
Phone
(707) 762-7678
Fax
(707) 762-7679
NPI assigned
Oct 26, 2006
Last updated
May 16, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 16, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X PT10959 CA Primary

Addresses

Primary practice location

224A Weller St
Petaluma, CA 94952-3136

Mailing address

224A Weller St
Petaluma, CA 94952-3136
Phone (707) 762-7678

Other identifiers 3

IdentifierTypeStateIssuer
093769OtherCAHEALTHNET PROVIDER ID
677476OtherCAACN/BLUE SHIELD PROVIDER
PT0109590MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110915000330 CA Practitioner - Physical Therapist in Private Practice 9931292869 Receives reassigned benefits from 1 practitioner
Practice locations: Petaluma, CA

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
University of California, San Francisco School of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

224 A Weller St
Petaluma, CA 94952-3410
Phone (707) 762-7678

Merit-based Incentive Payment System (MIPS)

Final score
91.03 of 100Reported as group
Quality
85
Improvement activities
40
Cost
90.11

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT10959CAMDOrthopedic Physical Therapist

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368662400000",
    "number": "1548345390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224A WELLER ST",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949523136",
            "telephone_number": "707-762-7678",
            "fax_number": "707-762-7679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224A WELLER ST",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949523136",
            "telephone_number": "707-762-7678",
            "fax_number": "707-762-7679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAUK",
        "first_name": "MITCHELL",
        "credential": "PT OCS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-26",
        "last_updated": "2013-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CA",
            "license": "PT10959",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET PROVIDER ID",
            "identifier": "093769",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACN/BLUE SHIELD PROVIDER",
            "identifier": "677476",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PT0109590",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Petaluma, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2013; 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.