NPIMap

Individual provider Active NPI

Michael Dennis Kifune, MD

  • Family Medicine Physician
  • San Andreas, CA
National Provider Identifier
1578568614
Registry record updated Sep 24, 2014
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Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G39833 Issued in CA
Practice address
1333 Highway 49
San Andreas, CA 95249-9618
Phone
(209) 755-1400
Fax
(209) 755-1430
NPI assigned
Jun 16, 2005
Last updated
Sep 24, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X G39833 CA Primary

Addresses

Primary practice location

1333 Highway 49
San Andreas, CA 95249-9618

Mailing address

PO Box 939
Angels Camp, CA 95222-0939
Phone (209) 754-6240

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090120000153 CA Practitioner - Family PracticePractitioner - Internal Medicine 2264435767 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of California, Irvine, California College of Medicine, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mark Twain Medical CenterGroup PAC ID 8820073711, 27 clinicians

Practice addresses (Care Compare)

2182 Hwy 4
Suite A100
Arnold, CA 95223-7281
Phone (209) 754-9232

590 Stanislaus Ave
Angels Camp, CA 95222-9355
Phone (209) 736-0813

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G39833CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mark Twain Medical Center CurrentSince Dec 5, 2022 Accepting new patients
Sandra J. Shetzline, DO Inc Family Medicine Past Accepting new patients

Locations

2182 Hwy 4
Ste A
Arnold, CA 95223

2182 Hwy 4
Ste A100
Arnold, CA 95223
Phone (209) 754-9232

430 Sawmill Creek Rd
Copperopolis, CA 95228
Phone (209) 785-0000

12140 New York Ranch Rd
Jackson, CA 95642
Phone (209) 257-2400

702 Mountain Ranch Rd
San Andreas, CA 95249
Phone (209) 754-0870

768 Mountain Ranch Rd
San Andreas, CA 95249
Phone (209) 464-6422

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411516800000",
    "number": "1578568614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 939",
            "city": "ANGELS CAMP",
            "state": "CA",
            "postal_code": "952220939",
            "telephone_number": "209-754-6240",
            "fax_number": "866-894-1902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1333 HIGHWAY 49",
            "city": "SAN ANDREAS",
            "state": "CA",
            "postal_code": "952499618",
            "telephone_number": "209-755-1400",
            "fax_number": "209-755-1430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIFUNE",
        "first_name": "MICHAEL",
        "middle_name": "DENNIS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2014-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G39833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Andreas, CA

Sources for this page

Verify at the official NPI Registry.