NPIMap

Individual provider Active NPI

Mark V Godiksen, M.D.

  • Internal Medicine Physician
  • Clovis, CA
National Provider Identifier
1760518245
Registry record updated Jun 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A43850 Issued in CA
Practice address
688 Medical Center Dr E
Suite 106
Clovis, CA 93611-6807
Phone
(559) 297-8604
Fax
(559) 297-0625
NPI assigned
Feb 26, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 18, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A43850 CA Primary

Addresses

Primary practice location

688 Medical Center Dr E
Suite 106
Clovis, CA 93611-6807

Mailing address

688 Medical Center Dr E
Suite 106
Clovis, CA 93611-6807
Phone (559) 297-8604

Other identifiers 1

IdentifierTypeStateIssuer
00A438500MedicaidCA

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
I20081203000358 CA Practitioner - Internal Medicine 6002977568 Reassigns benefits to 1 organization
Practice locations: Clovis, CA

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Iowa, RJ & L Carver College of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

688 Medical Ctr Dr E
Suite 106
Clovis, CA 93611-6807
Phone (559) 297-8604

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions38
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A43850CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fresno Community Hospital and Medical Center CurrentSince Feb 19, 2011 Accepting new patients
Clovis Community Medical Center CurrentSince Feb 19, 2011 Accepting new patients
Fresno Community Hospital and Medical Center Current Accepting new patients
Fresno Community Hospital and Medical Center Past Accepting new patients
Mark Godiksen PastSince Jan 1, 1990 Accepting new patients

Locations

2755 Herndon Ave
Clovis, CA 93611
Phone (559) 323-4000

2823 Fresno St
Fresno, CA 93721
Phone (559) 459-3965

Organizations & group practices 5

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.

Hospital & facility affiliations 6

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": "1172448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213747200000",
    "number": "1760518245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "688 MEDICAL CENTER DR E",
            "address_2": "SUITE 106",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936116807",
            "telephone_number": "559-297-8604",
            "fax_number": "559-297-0625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "688 MEDICAL CENTER DR E",
            "address_2": "SUITE 106",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936116807",
            "telephone_number": "559-297-8604",
            "fax_number": "559-297-0625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GODIKSEN",
        "first_name": "MARK",
        "middle_name": "V",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-26",
        "last_updated": "2008-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A43850",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A438500",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clovis, CA

Sources for this page

Verify at the official NPI Registry.