Mark J Freeman, MD
Individual provider Active NPI Family Medicine Physician · Clearlake, CA
NPI 1801898929 · NPPES record last updated Apr 17, 2009
Key facts
- NPI
- 1801898929
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- G47688 (CA)
- Practice address
- 15322 Lakeshore Dr
Ste 101
Clearlake, CA 95422-9815 - Phone
- (707) 995-1362
- Fax
- (707) 995-7057
- NPI assigned
- Jun 1, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040108000679 | CA | Practitioner - Family Practice | 7810896750 | Practice locations: Clearlake, CA |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mark Freeman, MD | Family Medicine | Past |
Accepting new patients |
| Michael R. Cosenza, DPM, Inc. | Past |
Accepting new patients | |
| Quantum Healthcare Medical Associates Inc. | Family Medicine | Past | Accepting new patients |
Interoperability endpoints
- mark.freeman.p1@direct.lcthc.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | G47688 | CA | Yes |
Addresses
Primary practice location
15322 Lakeshore Dr
Ste 101
Clearlake, CA 95422-9815
Mailing address
15322 Lakeshore Dr
Ste 101
Clearlake, CA 95422-9815
Phone (707) 995-1362
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G476880 | Medicaid | CA | |
| P00660683 | Other | CA | MEDICARE RAILROAD # |
| 080150278 | Other | MEDICARE RAILROAD # |
Other providers in Clearlake, CA
- Debra Marie Fleming
- Angelic Julia Flores
- Yolanda Estella Flores
- Leslie Suzanne Frances
- Katherine Judith Freeman
- Nadya Friedman
- Lori Frinzell
- Jennifer Anne Frolich
- Wendy Fullam
- Rebecca Ann Furia
All providers in Clearlake, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 17, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.