Frederick William Penczak, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

00A685120 Issued in CA

Practice address

78 Creekside Dr
San Rafael, CA 94903-1055

Phone

(707) 939-7411

Fax

(707) 939-1617

NPI assigned

Nov 6, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

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 1

Specialty

General SurgeryAlso: Neurosurgery, Orthopedic Surgery

Education

Medical College of Pennsylvania, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Novato Community Hospital Hospital, Novato, CA, CCN 050131
• Marinhealth Medical Center Hospital, Greenbrae, CA, CCN 050360

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Marin General Hospital

  • General Acute Care Hospital
  • Greenbrae, CA
  • NPI 1396725677
  Care Compare affiliation
• Sutter Bay Hospitals

  • General Acute Care Hospital
  • Novato, CA
  • NPI 1104059153
  Care Compare affiliation

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398384000000",
    "number": "1841379070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1964",
            "city": "SONOMA",
            "state": "CA",
            "postal_code": "954761964",
            "telephone_number": "707-939-7411",
            "fax_number": "707-939-1617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "78 CREEKSIDE DR",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949031055",
            "telephone_number": "707-939-7411",
            "fax_number": "707-939-1617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENCZAK",
        "first_name": "FREDERICK",
        "middle_name": "WILLIAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-06",
        "last_updated": "2014-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "00A685120",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A685120",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberley Rose Peirano, DACM, LAC
• David James Pelfini, DDS
• Debra L Pellinacci
• Josephine Singer Peltz
• Donna Penales
• Linda Penry IX
• Dana Pepp, LCSW
• Madeline Alexia Perez Alegria
• Raquel Margarita Perez Escobosa, LCSW
• Johanna Vanessa Perez Gallardo

• Surgery Physician in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2014; 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.