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DR. MARIO FERNANDO SAN BARTOLOME JR. MD
NPI 1154420024
Preventive Medicine - Addiction Medicine in Westminster, CA

Active since September 21, 2006PECOS EnrolledAccepts Medicare Assignment
5405 GARDEN GROVE BLVD STE 102, WESTMINSTER, CA 92683(714) 598-3707(714) 422-0260 Get Directions Write a Review

NPPES record last updated: August 8, 2019. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Aug 8, 2019, Jan 29, 2019, Oct 21, 2016 and 4 more (7 updates tracked since 2015).

About Dr. Mario Fernando San Bartolome Jr. Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. MARIO FERNANDO SAN BARTOLOME JR. MD (NPI 1154420024) is an individual addiction medicine provider in Westminster, California, licensed in California (A89818) and active in the NPI registry since September 2006. He is enrolled in Medicare PECOS and is a graduate of University Of California, Irvine, California College Of Medicine (2003).

NPPES Registry Identity

NPI1154420024
Entity TypeIndividualMale
Primary Taxonomy2083A0300X
Provider Legal NameDR. MARIO FERNANDO SAN BARTOLOME JR.Credential: MD
Location Address5405 GARDEN GROVE BLVD STE 102Westminster, CA 92683-1887
Mailing Address5405 Garden Grove Blvd Ste 102Westminster, CA 92683-1887 · (714) 598-3707 · Fax (714) 422-0260
Phone(714) 598-3707
Fax(714) 422-0260
Sole ProprietorNo
Medical School CMSUniversity Of California, Irvine, California College Of MedicineGraduated 2003
Enumeration DateSeptember 21, 2006
Last NPPES UpdateAugust 8, 20197 updates tracked since enumeration
✔ NPI 1154420024 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyPreventive Medicine · Addiction MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2083A0300X
License✔ Licensed in CA · A89818
Definition
A physician engaged in the subspecialty practice of Addiction Medicine who specializes in the prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction.
Also ListedSpecialistTaxonomy 174400000X · License A89818 (CA)
Also ListedFamily Medicine · Adolescent MedicineTaxonomy 207QA0000X · License A89818 (CA)
Also ListedFamily Medicine · Adult MedicineTaxonomy 207QA0505X · License A89818 (CA)
5405 GARDEN GROVE BLVD STE 102, Westminster, CA 92683
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Mario Fernando San Bartolome Jr. Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9032273503
PECOS Enrollment IDI20090128000104
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Mario San Bartolome reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Kcs, Inc.
6.0 mi
Federally Qualified Health Center (FQHC)
7212 ORANGETHORPE AVE STE 9A
Buena Park, CA 90621
  • Reassigned Medicare billing, California enrollment
  • 32 clinicians in this Medicare group
NPI 1861525602 (714) 503-6550

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92683 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$142.39 typical visit price
range $62.96 – $187.60
Typical copayment $35.59 (range $15.74 – $46.90)
Most-billed visit code 99204
Established Patient
$109.96 typical visit price
range $20.84 – $153.61
Typical copayment $27.49 (range $5.21 – $38.40)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mario San Bartolome's NPI number?

The NPI number for Mario San Bartolome is 1154420024. It was assigned to this individual provider in the NPPES registry on September 21, 2006.

Where is Mario San Bartolome located?

Mario San Bartolome practices at 5405 Garden Grove Blvd Ste 102, Westminster, CA 92683. The listed phone number is (714) 598-3707.

What is Mario San Bartolome's specialty?

The primary specialty registered for this NPI is Preventive Medicine, specializing in Addiction Medicine, with taxonomy code 2083A0300X.

Is Mario San Bartolome enrolled in Medicare?

Yes. Mario San Bartolome is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Mario San Bartolome's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mario San Bartolome reassigns Medicare benefits to Kcs, Inc. (Buena Park, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mario San Bartolome's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Mario San Bartolome was last updated on August 8, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.