Mark A Hallbourg, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT10773 Issued in CA

Practice address

11930 Heritage Oak PL
Suite 9
Auburn, CA 95603-2458

Phone

(530) 887-8785

Fax

(530) 887-8112

NPI assigned

Sep 7, 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

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sutter Valley Medical FoundationGroup PAC ID 9830094515, 2,473 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Sutter Valley Medical Foundation

  • Multi-Specialty Clinic/Center
  • Modesto, CA
  • NPI 1669846986
  Medicare reassignment Care Compare group NPD
• Sutter Valley Medical Foundation

  • Multi-Specialty Clinic/Center
  • Fairfield, CA
  • NPI 1184859894

  Physical Therapist

  NPD

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437955200000",
    "number": "1932203387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10470 OLD PLACERVILLE RD",
            "address_2": "SUITE 100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958272539",
            "telephone_number": "800-470-0071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11930 HERITAGE OAK PL",
            "address_2": "SUITE 9",
            "city": "AUBURN",
            "state": "CA",
            "postal_code": "956032458",
            "telephone_number": "530-887-8785",
            "fax_number": "530-887-8112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALLBOURG",
        "first_name": "MARK",
        "middle_name": "A",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-07",
        "last_updated": "2015-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT10773",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PT0107730",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelly J Haakenson, AMFT
• Janine Mary Hackland
• R Edmond Haddad, MS DDS
• Paula Joan Hajewski, P.T.
• Chelsea Nicole Haldeman
• Brian John Halloran, PT
• Jennifer Ham, MSW
• Michele Elizabeth Hamburg
• Jordan A Hamilton, PHD
• Abigail Grace Hanaway

• Physical Therapist in Auburn, CA
• Providers in Auburn, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.