Individual provider Active NPI

Mark V Tetz, M.D.

  • Family Medicine Physician
  • Visalia, CA
National Provider Identifier
1891779138
Registry record updated Apr 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A54646 Issued in CA
Practice address
311 W Noble Ave
Visalia, CA 93277-2669
Phone
(559) 625-9200
NPI assigned
Nov 30, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A54646 CA Primary

Addresses

Primary practice location

311 W Noble Ave
Visalia, CA 93277-2669

Mailing address

311 W Noble Ave
Visalia, CA 93277-2669
Phone (559) 625-9200

Other identifiers 1

IdentifierTypeStateIssuer
00A546460MedicaidCA

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20080513000239 CA Practitioner - Family Practice 1254345937 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Visalia Family Practice Medical GroupGroup PAC ID 9830139179, 6 clinicians

Practice addresses (Care Compare)

107 N Hall St
Suite D
Visalia, CA 93291-5850
Phone (559) 625-9200

Hospital & facility affiliations

  • Kaweah Health Home Health Home health agency, Visalia, CA, CCN 057255
  • Kaweah Health Medical Center Hospital, Visalia, CA, CCN 050057

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions100
Removal or shaving of skin growth15
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A54646CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Visalia Family Practice Medical Group Family Medicine CurrentSince Mar 1, 2008 Accepting new patients

Locations

311 W Noble Ave
Visalia, CA 93277
Phone (559) 625-9200

107 N Hall St
Ste D
Visalia, CA 93291
Phone (559) 625-9200

311 W Noble Ave
Ste 202
Visalia, CA 93277
Phone (559) 625-9200

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EAFIAA

Organizations & group practices 1

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 2

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": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303344000000",
    "number": "1891779138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 W NOBLE AVE",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932772669",
            "telephone_number": "559-625-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 W NOBLE AVE",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932772669",
            "telephone_number": "559-625-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TETZ",
        "first_name": "MARK",
        "middle_name": "V",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-30",
        "last_updated": "2011-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A54646",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A546460",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Visalia, CA

Sources for this page

Verify at the official NPI Registry.