Active NPI
Mark J Kasselik, MD
- Nephrology Physician
- San Francisco, CA
National Provider Identifier
1891860193
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- G62355
- Practice address
- 2100 Webster Street
Ste 405
San Francisco, CA 94115 - Phone
- (415) 923-3456
- Fax
- (415) 923-3121
- NPI assigned
- Nov 21, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | G62355 | CA | Primary |
Addresses
Primary practice location
2100 Webster Street
Ste 405
San Francisco, CA 94115
Mailing address
2100 Webster Street
Ste 405
San Francisco, CA 94115
Phone (415) 923-3456
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G623551 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G62355 | CA | MD | Nephrology Physician |
Interoperability endpoints
- mark.kasselik.1@18263.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374105600000",
"number": "1891860193",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 WEBSTER STREET",
"address_2": "STE 405",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "94115",
"telephone_number": "415-923-3456",
"fax_number": "415-923-3121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 WEBSTER STREET",
"address_2": "STE 405",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "94115",
"telephone_number": "415-923-3456",
"fax_number": "415-923-3121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KASSELIK",
"first_name": "MARK",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-21",
"last_updated": "2013-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "CA",
"license": "G62355",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G623551",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.