Individual provider Active NPI

Mark Alan Hacholski, M.D.

  • Family Medicine Physician
  • Chula Vista, CA
National Provider Identifier
1568995694
Registry record updated Dec 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A169591 Issued in CA
Practice address
525 Third Ave
Chula Vista, CA 91910-5696
Phone
(619) 515-2424
NPI assigned
Apr 5, 2017
Last updated
Dec 13, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 84641 SC
Family Medicine Physician 207Q00000X A169591 CA Primary

Addresses

Primary practice location

525 Third Ave
Chula Vista, CA 91910-5696

Mailing address

525 Third Ave
Chula Vista, CA 91910-5696

Other identifiers 1

IdentifierTypeStateIssuer
846419MedicaidSC

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20221012002666 CA Practitioner - Family Practice 4981029899 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sharp Rees-Stealy Medical Group IncGroup PAC ID 8628972759, 872 clinicians

Practice addresses (Care Compare)

10670 Wexford St
San Diego, CA 92131-3940
Phone (858) 621-4002

480 H St
Chula Vista, CA 91910-4328
Phone (858) 499-2600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.67 of 100Reported as group
Quality
81.04
Promoting interoperability
99
Improvement activities
40
Cost
82.04

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A169591CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sharp Rees-Stealy Medical Group, Inc CurrentSince Feb 5, 2024 Accepting new patients
Sharp Rees-Stealy Medical Group, Inc Family Medicine CurrentSince Feb 5, 2024 Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Sep 28, 2022 Accepting new patients
Family Health Centers of San Diego, Inc Current Accepting new patients
Family Health Centers of San Diego, Inc. CurrentSince Sep 28, 2022 Accepting new patients
Sharp Rees-Stealy Medical Center Past Accepting new patients
Baptist Easley Hospital Past Accepting new patients
Prisma Health Midlands Past Accepting new patients

Locations

525 Third Ave
Chula Vista, CA 91910
Phone (619) 585-4050

1809 National Ave
San Diego, CA 92113
Phone (619) 515-2500

2020 Genesee Ave
San Diego, CA 92123
Phone (619) 268-9500

3544 30th St
San Diego, CA 92104
Phone (619) 515-2424

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

Interoperability endpoints

  • Direct secure messaging: mark.hacholski@direct.myhealthep.org
  • Direct secure messaging: mhacholski136294@sharphealthcare.direct-ci.com

Organizations & group practices 8

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1491350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734048000000",
    "number": "1568995694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 THIRD AVE",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919105696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 THIRD AVE",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919105696",
            "telephone_number": "619-515-2424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HACHOLSKI",
        "first_name": "MARK",
        "middle_name": "ALAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-05",
        "last_updated": "2024-12-13",
        "certification_date": "2024-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "84641",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A169591",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "846419",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chula Vista, CA

Sources for this page

Verify at the official NPI Registry.