NPIMap

Individual provider Active NPI

Mark T Fahlen, MD

  • Nephrology Physician
  • Modesto, CA
National Provider Identifier
1679539415
Registry record updated Aug 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A81212 Issued in CA
Practice address
1400 Florida Ave
Suite 109
Modesto, CA 95350-4422
Phone
(209) 544-2910
NPI assigned
Apr 21, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 2, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A81212 CA
Nephrology Physician 207RN0300X A81212 CA Primary

Addresses

Primary practice location

1400 Florida Ave
Suite 109
Modesto, CA 95350-4422

Mailing address

1400 Florida Ave
Suite 109
Modesto, CA 95350-4422
Phone (209) 544-2910

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
I20040908000652 CA Practitioner - Nephrology 1850367111 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Albany Medical College of Union University, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1400 Florida Ave
Suite 109
Modesto, CA 95350-4444
Phone (209) 544-2910

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.62 of 100Reported as individual
Quality
75.83
Promoting interoperability
86
Improvement activities
40
Cost
81.23

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A81212CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mark T. Fahlen, MD, Inc. a Professional Medical Corporation Nephrology CurrentSince Jun 1, 2008 Accepting new patients
Doctors Medical Center of Modesto, Inc. Past Accepting new patients
Sutter Valley Hospitals Past Accepting new patients
Modesto Kidney Medical Group Nephrology PastSince Nov 24, 2020 Accepting new patients

Locations

1400 Florida Ave
Ste 109
Modesto, CA 95350
Phone (209) 544-2910

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: mark.fahlen.1@1735.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/1735/brand/1/csg/1/fhir/r4
  • Direct secure messaging: mfahlen244002@hisp.ehr.sutterhealth.org

Organizations & group practices 4

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": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312243200000",
    "number": "1679539415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 FLORIDA AVE",
            "address_2": "SUITE 109",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504422",
            "telephone_number": "209-544-2910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 FLORIDA AVE",
            "address_2": "SUITE 109",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504422",
            "telephone_number": "209-544-2910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAHLEN",
        "first_name": "MARK",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-21",
        "last_updated": "2011-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A81212",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A81212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.