Mark David Elliott, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

803-A133148 Issued in CA

Practice address

58 W Portal Ave Ste 722
San Francisco, CA 94127-1304

Phone

(415) 727-6766

NPI assigned

Apr 9, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1365465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719964800000",
    "number": "1922441997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "58 W PORTAL AVE STE 722",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941271304",
            "telephone_number": "415-727-6766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "58 W PORTAL AVE STE 722",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941271304",
            "telephone_number": "415-727-6766"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1090 S Wadsworth Blvd Unit C5014",
            "address_purpose": "LOCATION",
            "city": "Lakewood",
            "state": "CO",
            "postal_code": "802264328",
            "country_code": "US",
            "telephone_number": "415-727-6766",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "MARK",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-04-09",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CO",
            "license": "DR.0061904",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "803-A133148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Justin Elliott
• Kathleen P. Elliott
• Kathryn Alice Teresa Elliott, MS, LCGC
• Kristian Elliott
• Lea Mine Chen Elliott
• Megan Elliott, LMFT
• Stephanie Elliott
• Ellis Pharmacy
• Chrystal Ellis Sweazey
• Sarah Ellis-Falik

• Psychiatry Physician in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.