Mark Rollo Halverson, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

C195815 Issued in CA

Practice address

725 Welch Rd
Palo Alto, CA 94304-1601

Phone

(650) 497-8000

NPI assigned

Jul 10, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in OH, PA, CA3 enrollments

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 3

Specialty

Diagnostic Radiology

Education

University of California, Davis School of Medicine, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

LPCH Medical Group Div of LucileGroup PAC ID 0840298543, 332 clinicians

Practice addresses (Care Compare)

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.

• LPCH Medical Group Div of Lucile

  • Children's Hospital
  • Palo Alto, CA
  • NPI 1417907940
  Medicare reassignment Care Compare group NPD
• California Advanced Imaging Medical Associates Inc

  • Diagnostic Radiology Physician
  • San Francisco, CA
  • NPI 1881646909

  Neuroradiology

  Medicare reassignment NPD
• Stanford Health Care

  • General Acute Care Hospital
  • Stanford, CA
  • NPI 1437292927

  Diagnostic Radiology

  Medicare reassignment NPD
• Children'S Radiological Institute, Inc

  • Pediatric Radiology Physician
  • Columbus, OH
  • NPI 1508895608
  Medicare reassignment NPD
• University of Penn-Medical Group

  • Gynecologic Oncology Physician
  • Philadelphia, PA
  • NPI 1235527342
  Medicare reassignment NPD
• Stanford Health Care

  • Radiation Oncology Physician
  • Pleasanton, CA
  • NPI 1124561758

  Diagnostic Radiology

  NPD
• Stanford Health Care

  • Specialty Pharmacy
  • Mountain View, CA
  • NPI 1760366132
  NPD
• University of Penn-Medical Group

  • Surgery Physician
  • Philadelphia, PA
  • NPI 1033507157
  NPD
• University of Penn-Medical Group

  • Surgical Oncology Physician
  • Philadelphia, PA
  • NPI 1871981985
  NPD
• Clinical Care in Radiology

  • Physician Assistant
  • Fort Worth, TX
  • NPI 1578331393
  NPD (past)

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

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1619175890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 WELCH RD",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943041601",
            "telephone_number": "650-497-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 WELCH RD",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943041601",
            "telephone_number": "650-497-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "816 W Cannon St",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "761043146",
            "country_code": "US",
            "telephone_number": "817-321-0387",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HALVERSON",
        "first_name": "MARK",
        "middle_name": "ROLLO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-10",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "CA",
            "license": "C195815",
            "primary": false
        },
        {
            "code": "2085P0229X",
            "taxonomy_group": "",
            "desc": "Radiology, Pediatric Radiology",
            "state": "PA",
            "license": "MD445798",
            "primary": false
        },
        {
            "code": "2085P0229X",
            "taxonomy_group": "",
            "desc": "Radiology, Pediatric Radiology",
            "state": "TX",
            "license": "P8785",
            "primary": false
        },
        {
            "code": "2085P0229X",
            "taxonomy_group": "",
            "desc": "Radiology, Pediatric Radiology",
            "state": "CA",
            "license": "C195815",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "C195815",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121715004",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121715008",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "285250104",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan Hall, RD
• James Lloyd Hallenbeck, MD
• Catherine Hallet, RDN
• Courtney Hallum, MD
• Christina Lee Halstead, MD
• Ana Marija Halvorson
• Rita Hamad, M.D.
• Ron Hamako, DDS
• Kris Saeko Hamamoto, D.D.S.
• Syed Morad Hameed, MD

• Diagnostic Radiology Physician in Palo Alto, CA
• Providers in Palo Alto, CA by specialty
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; 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.
• 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.