Dallas J Mark

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

1466 Lincoln Ave
San Rafael, CA 94901-2021

Phone

(415) 457-3755

Fax

(415) 457-0849

NPI assigned

Sep 6, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2016

Medicare assignment

May accept Medicare assignment

Group practices

Berkeley Therapy InstituteGroup PAC ID 2264414283, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Berkeley Therapy Institute

  • Psychiatry Physician
  • Berkeley, CA
  • NPI 1255497814
  Medicare reassignment Care Compare group NPD
• Marin Treatment Center

  • Methadone Clinic
  • San Rafael, CA
  • NPI 1437377421
  NPD (past)

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

{
    "created_epoch": "1315267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315267200000",
    "number": "1689955569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1466 LINCOLN AVE",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949012021",
            "telephone_number": "415-457-3755",
            "fax_number": "415-457-0849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1466 LINCOLN AVE",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949012021",
            "telephone_number": "415-457-3755",
            "fax_number": "415-457-0849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARK",
        "first_name": "DALLAS",
        "middle_name": "J",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-06",
        "last_updated": "2011-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marinidence Opco, LLC
• Marion Kregeloh
• Drew E Maris
• Linda Maria Mariscal, R.N., P.H.N.
• Mark Drucker, D.P.M., a Professional Corporation
• Alex Stephen Markels, LCSW
• Stephen Marks, PH.D.
• Donald Wayne Marlatt, RAS
• Jonathan Louis Marlowe, PHD
• Jeff Marquardt

• Counselor in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2011; 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.