Kelisha Mark

Primary specialty

Social WorkerTaxonomy code 104100000X

License

100364 Issued in NY

Practice address

77 Water St
New York, NY 10005-4401

Phone

(347) 440-5869

NPI assigned

Dec 22, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kelisha Melbourne Former name

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Integrity Social Work Services LLCGroup PAC ID 4880609528, 74 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
• FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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.

• Integrity Social Work Services LLC

  • Mental Health Counselor
  • Staten Island, NY
  • NPI 1972715456
  Medicare reassignment Care Compare group NPD
• The New York and Presbyterian Hospital

  • General Acute Care Hospital
  • New York, NY
  • NPI 1194832477
  NPD (past)

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

{
    "created_epoch": "1640131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640131200000",
    "number": "1912667692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 WATER ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100054401",
            "telephone_number": "347-440-5869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 WATER ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100054401",
            "telephone_number": "347-440-5869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARK",
        "first_name": "KELISHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-22",
        "last_updated": "2021-12-22",
        "certification_date": "2021-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "100364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELISHA",
            "last_name": "MELBOURNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Helen Mark
• Joel Mark, DDS
• Julia Mark
• Julie Beth Mark
• Katherine Mark, MD
• Laurence Mark, M.D.
• Laurie Mark
• Martin O Mark, OD
• Meryl Schlussel Mark, MD
• Nakesia Mark

• Social Worker in New York, NY
• Providers in New York, NY by specialty
• Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2021; 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.