Mark L Koransky, MD

Offices

4 locations · Sutter Bay Medical Foundation · Washington Township Medical Foundation

Looking this up.

Hospitals listed: Washington Hospital. That is not proof they admit you there this week.

Plans that list them

1 plan · 1 carrier

A missing listing does not mean out of network. Directories change, and a listing does not cover every office. Call Dr. Koransky’s office to confirm they take your plan. Ask about the office you use, its medical group, referrals and appointments.

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Plans whose provider directory lists this clinician

SCAN Strive (HMO C-SNP)	SCAN Health Plan	Listed	Oct 3, 2026

California Medical Board record

Licence A63039 · Current

Licensed to practise in California · since 1997 · expires 2027-03-31 · University of California San Francisco School of Medicine.

No disciplinary actions, convictions, malpractice judgments or citations in this record.

Hospitals they work in

1 hospital

These rate the hospital, not this clinician. Most measures at most hospitals are no different from the national rate.

Washington HospitalFremont, CAAcute Care Hospital · Government - Hospital District or Authority · Has an emergency department · Birthing-friendlyPart of Washington Hospital Healthcare SystemPatients rate it 3 of 5 · 71% would definitely recommend it
Overall rating: 2 of 5 starsBetter than the national rate — Catheter Associated Urinary Tract Infections (ICU + select Wards): 0.188, Oct 2024 – Sep 2025Better than the national rate — Central Line Associated Bloodstream Infection (ICU + select Wards): 0, Oct 2024 – Sep 2025Better than the national rate — Clostridium Difficile (C.Diff): 0.164, Oct 2024 – Sep 2025

See every measure and the patient survey for Washington Hospital

Behind the star rating — Deaths: 0 better, 8 the same, 0 worse of 8 measures. Safety: 2 better, 5 the same, 0 worse of 7 measures. Readmissions: 1 better, 6 the same, 4 worse of 11 measures. The star rating is worked out from an earlier period than the measures below, so the two can disagree.

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Every scored measure at Washington Hospital

Catheter Associated Urinary Tract Infections (ICU + select Wards)Infections	0.188	Better	Oct 2024 – Sep 2025
Central Line Associated Bloodstream Infection (ICU + select Wards)Infections	0	Better	Oct 2024 – Sep 2025
Clostridium Difficile (C.Diff)Infections	0.164	Better	Oct 2024 – Sep 2025
Abdominopelvic accidental puncture or laceration rateComplications and deaths	0.88 (0 to 1.88) · 1,112 cases	No different	Jul 2022 – Jun 2024
CMS Medicare PSI 90: Patient safety and adverse events compositeComplications and deaths	0.92 (0.59 to 1.24)	No different	Jul 2022 – Jun 2024
Death rate among surgical inpatients with serious treatable complicationsComplications and deaths	192.95 (139.54 to 246.36) · 48 cases	No different	Jul 2022 – Jun 2024
Death rate for CABG surgery patientsComplications and deaths	2 · 27 cases	None	Jul 2022 – Jun 2025
Death rate for COPD patientsComplications and deaths	7.4 · 164 cases	None	Jul 2022 – Jun 2025
Death rate for heart attack patientsComplications and deaths	12.1 · 199 cases	None	Jul 2022 – Jun 2025
Death rate for heart failure patientsComplications and deaths	8.9 · 463 cases	None	Jul 2022 – Jun 2025
Death rate for pneumonia patientsComplications and deaths	15.6 · 661 cases	None	Jul 2022 – Jun 2025
Death rate for stroke patientsComplications and deaths	9.3 · 174 cases	None	Jul 2023 – Jun 2025
Hybrid Hospital-Wide All-Cause Risk Standardized Mortality RateComplications and deaths	3.7 · 2,550 cases	None	Jul 2024 – Jun 2025
Iatrogenic pneumothorax rateComplications and deaths	0.15 (0 to 0.35) · 6,970 cases	No different	Jul 2022 – Jun 2024
In-hospital fall-associated fracture rateComplications and deaths	0.21 (0.02 to 0.4) · 7,108 cases	No different	Jul 2022 – Jun 2024
Perioperative pulmonary embolism or deep vein thrombosis rateComplications and deaths	3.82 (1.73 to 5.91) · 1,370 cases	No different	Jul 2022 – Jun 2024
Postoperative acute kidney injury requiring dialysis rateComplications and deaths	1.52 (0 to 3.17) · 589 cases	No different	Jul 2022 – Jun 2024
Postoperative hemorrhage or hematoma rateComplications and deaths	1.75 (0.25 to 3.25) · 1,315 cases	No different	Jul 2022 – Jun 2024
Postoperative respiratory failure rateComplications and deaths	13.19 (5.83 to 20.56) · 600 cases	No different	Jul 2022 – Jun 2024
Postoperative sepsis rateComplications and deaths	4.91 (1.04 to 8.78) · 550 cases	No different	Jul 2022 – Jun 2024
Postoperative wound dehiscence rateComplications and deaths	1.66 (0.17 to 3.14) · 198 cases	No different	Jul 2022 – Jun 2024
Pressure ulcer rateComplications and deaths	0.14 (0 to 0.78) · 6,079 cases	No different	Jul 2022 – Jun 2024
Rate of complications for hip/knee replacement patientsComplications and deaths	3.7 · 114 cases	None	Apr 2023 – Mar 2025
MRSA BacteremiaInfections	0	No different	Oct 2024 – Sep 2025
SSI - Colon SurgeryInfections	1.367	No different	Oct 2024 – Sep 2025
Acute Myocardial Infarction (AMI) 30-Day Readmission RateUnplanned return visits	14.8 · 186 cases	None	Jul 2023 – Jun 2025
Heart failure (HF) 30-Day Readmission RateUnplanned return visits	21.9 · 480 cases	None	Jul 2023 – Jun 2025
Hospital return days for heart attack patientsUnplanned return visits	33.9 · 186 cases	None	Jul 2022 – Jun 2025
Hospital return days for heart failure patientsUnplanned return visits	26.5 · 553 cases	None	Jul 2022 – Jun 2025
Hospital return days for pneumonia patientsUnplanned return visits	36.8 · 648 cases	None	Jul 2022 – Jun 2025
Pneumonia (PN) 30-Day Readmission RateUnplanned return visits	18.5 · 590 cases	None	Jul 2023 – Jun 2025
Rate of emergency department (ED) visits for patients receiving outpatient chemotherapyUnplanned return visits	4.7 (3.2 to 6.9) · 169 cases	No different	Jan 2024 – Dec 2024
Rate of inpatient admissions for patients receiving outpatient chemotherapyUnplanned return visits	11.4 (8.5 to 14.9) · 169 cases	No different	Jan 2024 – Dec 2024
Rate of readmission after hip/knee replacementUnplanned return visits	5.4 · 130 cases	None	Jul 2023 – Jun 2025
Rate of readmission for CABGUnplanned return visits	11.1 · 41 cases	None	Jul 2023 – Jun 2025
Rate of readmission for chronic obstructive pulmonary disease (COPD) patientsUnplanned return visits	20.3 · 202 cases	None	Jul 2023 – Jun 2025
Rate of unplanned hospital visits after colonoscopy (per 1,000 colonoscopies)Unplanned return visits	13.7 (10.2 to 18.5) · 78 cases	No different	Jan 2022 – Dec 2024
Ratio of unplanned hospital visits after hospital outpatient surgeryUnplanned return visits	0.9 (0.7 to 1.1) · 974 cases	No different	Jan 2024 – Dec 2024

What patients said (812 patients answered, 19% of those asked)

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Patient survey stars by topic at Washington Hospital

Cleanliness	4
Nurse communication	3
Doctor communication	3
Communication about medicines	2
Discharge information	3
Overall hospital rating	3
Quietness	2
Recommend hospital	4

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Share of patients giving the best answer at Washington Hospital

Room was "always" clean	76%
Nurses "always" communicated well	77%
Doctors "always" communicated well	77%
Staff "always" explained	56%
Yes, staff "did" give patients this information	84%
Yes, staff "did" give patients information about help after discharge	84%
Doctors "always" explained things so they could understand	70%
Doctors "always" listened carefully	76%
Doctors "always" treated them with courtesy and respect	84%
Patients who gave a rating of "9" or "10" (high)	71%
Staff "always" explained new medications	70%
Nurses "always" explained things so they could understand	72%
Nurses "always" listened carefully	74%
Nurses "always" treated them with courtesy and respect	86%
"Always" quiet at night	46%
"YES", patients would definitely recommend the hospital	71%
Staff "always" explained possible side effects	42%
Yes, staff "did" give patients information about possible symptoms	84%

Original Medicare doctor bills

$87,929

Medicare paid this office $87,929 for 234 people.

This is what Medicare paid the clinician — not Medicare Advantage, and not the pharmacy.

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Largest Original Medicare bills

Partial removal of breast	14	$9,479	$558
New patient visit (45+ min)	42	$6,324	$151
Removal of external hemorrhoids by rubber banding	14	$5,820	$265
New patient visit (30+ min)	55	$5,381	$98
Repair of groin hernia using an endoscope	12	$5,015	$418

See all 13 services

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Every Original Medicare service billed

Partial removal of breast	14	$9,479	$558
New patient visit (45+ min)	42	$6,324	$151
Removal of external hemorrhoids by rubber banding	14	$5,820	$265
New patient visit (30+ min)	55	$5,381	$98
Repair of groin hernia using an endoscope	12	$5,015	$418
New patient visit (60+ min)	21	$4,348	$207
Short return visit (20+ min)	44	$4,061	$81
Biopsy or removal of deep lymph nodes of underarm	11	$2,192	$199
Return visit (30+ min)	18	$2,091	$116
Imaging of lymph nodes during surgery	11	$1,267	$115
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes	19	$1,266	$67
Initial hospital care with straightforward or low-level medical decision making at least 55 minutes	11	$1,103	$100
Subsequent hospital care with straightforward or low level of medical decision making, per day at least 25 minutes	16	$744	$44

Procedures Medicare counted

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Procedure volume Medicare published

Colonoscopy	1-10	None
Hernia repair - groin (open)	1-10	None
Hernia repair (minimally invasive)	1-10	None
Mastectomy	27	More than 84% of doctors who do this
Melanoma (skin cancer) excision	1-10	None
Removal of skin lesions	1-10	None

Who their Medicare patients are

234 Original Medicare patients in 2024. Average age 76 · Women 47% · Also on Medicaid 26% · Health risk score 1.27. At or below the middle of the specialty; the typical general surgery clinician is at 1.69.

Conditions among them: High blood pressure 71% · Diabetes 35% · Coronary heart disease 32% · Cancer 27% · Chronic kidney disease 26% · Atrial fibrillation 20% · Depression 18% · Heart failure 17% · COPD 13% · Dementia 11% · Stroke 10%.

The office billed $382,479, Medicare allowed $113,721 and paid $87,929; for 413 services of 62 kinds.

Original Medicare patients only. A risk score of 1.0 is the average Medicare patient; higher means sicker. Any count under 11 is hidden.

Year by year

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Original Medicare by year

2024	234	413	76	1.27	$382,479	$87,929
2023	224	433	75	1.22	$361,710	$85,998
2022	220	420	75	1.28	$337,838	$85,863
2021	237	467	73	1.16	$352,860	$92,666
2020	206	356	73	1.43	$299,542	$71,342
2019	246	471	73	1.28	$428,803	$101,155
2018	266	475	72	1.27	$418,088	$93,073
2017	233	419	74	1.48	$426,754	$91,106
2016	256	467	72	1.20	$436,695	$99,779
2015	250	465	73	1.50	$391,362	$98,173
2014	169	313	72	1.26	$277,991	$55,327
2013	133	252	70	1.15	$212,392	$44,062

Original Medicare only. A service billed for fewer than 11 people in a year is hidden, so the lines can add up to less than the year's total.

See the services billed each year

2023: 13 services

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Original Medicare services billed in 2023

Removal of external hemorrhoids by rubber banding	17	$9,565	$273
Partial removal of breast	15	$9,060	$566
New patient visit (30+ min)	73	$6,480	$89
Repair of groin hernia using an endoscope	13	$5,732	$441
New patient visit (45+ min)	30	$4,680	$156
Short return visit (20+ min)	40	$3,880	$84
New patient visit (60+ min)	19	$3,590	$189
Biopsy or removal of deep lymph nodes of underarm	14	$3,429	$245
Return visit (30+ min)	26	$2,687	$103
Imaging of lymph nodes during surgery	14	$1,642	$117
Diagnostic exam of anus using an endoscope	14	$1,622	$116
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes	11	$1,134	$71
Office for the evaluation and management of established patient that may not require presence of healthcare professional	12	$241	$19

2022: 14 services

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Original Medicare services billed in 2022

Removal of gallbladder using an endoscope	14	$8,300	$593
Partial removal of breast	11	$7,516	$578
New patient visit (45+ min)	46	$6,647	$144
Removal of external hemorrhoids by rubber banding	13	$5,547	$292
New patient visit (30+ min)	54	$5,226	$97
Repair of groin hernia using an endoscope	11	$3,783	$344
Short return visit (20+ min)	34	$3,030	$84
New patient visit (60+ min)	15	$2,923	$195
Initial hospital care with moderate level of medical decision making at least 75 minutes	11	$1,762	$160
Return visit (30+ min)	14	$1,711	$122
Diagnostic exam of anus using an endoscope	11	$1,221	$111
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes	16	$1,131	$63
Office for the evaluation and management of established patient that may not require presence of healthcare professional	41	$943	$22
New patient visit (15+ min)	14	$845	$60

2021: 14 services

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Original Medicare services billed in 2021

Removal of gallbladder using an endoscope	16	$8,977	$561
Partial removal of breast	12	$6,896	$575
New patient visit (30+ min)	60	$6,090	$101
Short return visit (20+ min)	63	$5,627	$76
New patient visit (60+ min)	25	$5,245	$210
New patient visit (45+ min)	24	$3,723	$155
Biopsy or removal of deep lymph nodes of underarm	11	$3,232	$294
Initial hospital care with moderate level of medical decision making at least 75 minutes	16	$2,891	$181
Return visit (30+ min)	16	$2,138	$126
Long return visit (40+ min)	11	$1,977	$180
Diagnostic exam of anus using an endoscope	16	$1,926	$113
New patient visit (15+ min)	22	$1,414	$64
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes	12	$868	$62
Office for the evaluation and management of established patient that may not require presence of healthcare professional	35	$860	$23

2020: 9 services

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Original Medicare services billed in 2020

Removal of gallbladder using an endoscope	12	$6,151	$513
New patient visit (30+ min)	54	$5,192	$96
New patient visit (45+ min)	34	$4,437	$131
New patient visit (60+ min)	18	$3,365	$187
Short return visit (20+ min)	36	$2,451	$61
Diagnostic exam of anus using an endoscope	14	$1,419	$101
Return visit (30+ min)	14	$1,377	$98
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes	14	$1,124	$66
New patient visit (15+ min)	18	$1,104	$61

2019: 9 services

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Original Medicare services billed in 2019

New patient visit (45+ min)	49	$7,230	$148
Repair of groin hernia using an endoscope	14	$6,039	$431
Initial hospital care with moderate level of medical decision making at least 75 minutes	22	$4,144	$173
Short return visit (20+ min)	51	$3,457	$61
Return visit (30+ min)	30	$3,113	$92
New patient visit (15+ min)	43	$2,464	$57
New patient visit (30+ min)	28	$2,436	$87
Diagnostic exam of anus using an endoscope	23	$2,157	$94
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes	20	$1,771	$66

2018: 12 services

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Original Medicare services billed in 2018

New patient visit (45+ min)	55	$7,570	$138
Repair of groin hernia using an endoscope	15	$6,278	$419
Short return visit (20+ min)	52	$3,645	$59
Insertion of central venous tube with port (5 years or older)	12	$3,459	$288
Removal of external hemorrhoids by rubber banding	11	$3,374	$260
New patient visit (30+ min)	35	$3,238	$93
New patient visit (60+ min)	16	$3,024	$189
Initial hospital care with moderate level of medical decision making at least 75 minutes	17	$2,859	$168
Return visit (30+ min)	29	$2,641	$85
New patient visit (15+ min)	39	$2,529	$65
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes	22	$1,928	$60
Diagnostic exam of anus using an endoscope	19	$1,645	$87

2017: 13 services

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Original Medicare services billed in 2017

Removal of gallbladder using an endoscope	21	$11,195	$533
New patient visit (45+ min)	58	$7,848	$135
Repair of groin hernia using an endoscope	14	$6,625	$473
Insertion of central venous tube with port (5 years or older)	13	$3,873	$298
New patient visit (30+ min)	33	$3,046	$92
Removal of external hemorrhoids by rubber banding	12	$2,915	$243
Initial hospital care with moderate level of medical decision making at least 75 minutes	16	$2,669	$167
Short return visit (20+ min)	33	$2,078	$55
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes	21	$1,518	$63
Return visit (30+ min)	18	$1,487	$78
Diagnostic exam of anus using an endoscope	16	$1,463	$86
New patient visit (15+ min)	24	$1,379	$57
Short return visit	14	$489	$31

2016: 10 services

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Original Medicare services billed in 2016

New patient visit (45+ min)	50	$7,087	$142
Initial hospital care with moderate level of medical decision making at least 75 minutes	22	$3,599	$156
Insertion of central venous tube with port (5 years or older)	11	$3,247	$295
New patient visit (15+ min)	53	$3,106	$59
Return visit (30+ min)	31	$2,640	$85
New patient visit (30+ min)	26	$2,455	$94
Short return visit	41	$1,899	$35
Diagnostic exam of anus using an endoscope	18	$1,656	$79
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes	17	$1,372	$60
Short return visit (20+ min)	14	$852	$61

2015: 10 services

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Original Medicare services billed in 2015

New patient visit (45+ min)	66	$9,328	$141
Removal of gallbladder using an endoscope	15	$8,777	$585
Initial hospital care with straightforward or low-level medical decision making at least 55 minutes	24	$2,826	$118
New patient visit (15+ min)	43	$2,727	$63
Diagnostic exam of anus using an endoscope	23	$2,273	$87
New patient visit (30+ min)	24	$2,247	$94
Short return visit	44	$2,221	$40
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes	24	$2,070	$63
Short return visit (20+ min)	25	$1,750	$62
Return visit (30+ min)	13	$1,398	$100

2014: 8 services

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Original Medicare services billed in 2014

New patient visit (45+ min)	42	$5,738	$137
Insertion of central venous tube with port (5 years or older)	11	$2,984	$271
New patient visit (30+ min)	29	$2,626	$91
Short return visit	37	$1,848	$34
New patient visit (15+ min)	26	$1,631	$63
Return visit (30+ min)	17	$1,437	$85
Diagnostic exam of anus using an endoscope	12	$1,002	$77
Short return visit (20+ min)	14	$808	$58

2013: 7 services

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Original Medicare services billed in 2013

New patient visit (45+ min)	26	$3,704	$142
New patient visit (60+ min)	19	$3,209	$169
New patient visit (30+ min)	20	$1,667	$83
Short return visit	28	$1,401	$40
New patient visit (15+ min)	22	$1,294	$59
Return visit (30+ min)	12	$1,012	$84
Short return visit (20+ min)	14	$834	$60

Drugs they prescribed that Part D paid

$436

Pharmacies billed $436 in 2024.

This is pharmacy cost, not the office bill, and not what patients paid.

Opioids were 89% of their Part D prescriptions (59 of 66) in 2024. A higher opioid share than 9 in 10 peers; the typical general surgery clinician is at 34%.

66 generic and 0 brand-name prescriptions · $436 in drug cost.

Part D prescriptions only. The opioid rate is opioid prescriptions as a share of all this clinician's Part D prescriptions; surgeons and pain specialists run higher than others, so it is shown against the same specialty.

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Largest Part D drug costs

Hydrocodone-Acetaminophen	32	$237	$7
Tramadol	21	$53	$2

Year by year

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Part D prescribing by year

2024	66	56	89% (59)	0%	$436
2023	79	65	92% (73)	0%	$551
2022	96	72	73% (70)	0%	$1,042
2021	93	71	79% (73)	0%	$706
2020	60	45	78% (47)	None	$714
2019	66	52	85% (56)	0%	$532
2018	79	65	82% (65)	0%	$686
2017	86	69	83% (71)	0%	$745
2016	77	62	81% (62)	0%	$640
2015	88	66	77% (68)	0%	$664
2014	64	48	73% (47)	0%	$780
2013	64	41	75% (48)	None	$606

Part D prescriptions only. A drug prescribed to fewer than 11 people in a year is hidden.

See the drugs prescribed each year

2023: 1 drug

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Part D drugs prescribed in 2023

Hydrocodone-Acetaminophen	59	$453	$8

2022: 1 drug

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Part D drugs prescribed in 2022

Hydrocodone-Acetaminophen	67	$455	$7

2021: 1 drug

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Part D drugs prescribed in 2021

Hydrocodone-Acetaminophen	65	$409	$6

2020: 1 drug

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Part D drugs prescribed in 2020

Hydrocodone-Acetaminophen	44	$303	$7

2019: 2 drugs

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Part D drugs prescribed in 2019

Acetaminophen-Codeine	29	$248	$9
Hydrocodone-Acetaminophen	21	$189	$9

2018: 2 drugs

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Part D drugs prescribed in 2018

Acetaminophen-Codeine	45	$301	$7
Hydrocodone-Acetaminophen	18	$152	$8

2017: 1 drug

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Part D drugs prescribed in 2017

Acetaminophen-Codeine	55	$379	$7

2016: 2 drugs

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Part D drugs prescribed in 2016

Acetaminophen-Codeine	41	$321	$8
Hydrocodone-Acetaminophen	12	$107	$9

2015: 2 drugs

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Part D drugs prescribed in 2015

Acetaminophen-Codeine	46	$329	$7
Hydrocodone-Acetaminophen	16	$180	$11

2014: 1 drug

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Part D drugs prescribed in 2014

Hydrocodone-Acetaminophen	40	$376	$9

2013: 1 drug

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Part D drugs prescribed in 2013

Hydrocodone-Acetaminophen	37	$240	$6

Money from drug and device companies

$928 in 2025

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Industry payments by year

2025	1	6	None	$928
2024	1	2	None	$359
2023	1	1	None	$17

Paid work is consulting, speaking, honoraria and royalties, as opposed to meals and travel.

A payment is not proof that care is biased.

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Payments by company

Intuitive Surgical	Da Vinci Surgical System	$928	6 payments Meals for Da Vinci Surgical System · 2025-02-18 · $130 Travel for Da Vinci Surgical System · 2025-01-17 · $19 Travel for Da Vinci Surgical System · 2025-01-17 · $194 Travel for Da Vinci Surgical System · 2025-01-17 · $245 Travel for Da Vinci Surgical System · 2025-01-03 · $322 Travel for Da Vinci Surgical System · 2025-01-03 · $19

See all 6 published payments

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Every published payment

Intuitive Surgical	Meals · 2025-02-18	Da Vinci Surgical System	$130
Intuitive Surgical	Travel · 2025-01-17	Da Vinci Surgical System	$19
Intuitive Surgical	Travel · 2025-01-17	Da Vinci Surgical System	$194
Intuitive Surgical	Travel · 2025-01-17	Da Vinci Surgical System	$245
Intuitive Surgical	Travel · 2025-01-03	Da Vinci Surgical System	$322
Intuitive Surgical	Travel · 2025-01-03	Da Vinci Surgical System	$19

See earlier years (2024, 2023)

2024: $359

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Payments by company in 2024

Intuitive Surgical	Da Vinci Surgical System	$359	2 payments Travel for Da Vinci Surgical System · 2024-10-24 · $19 Travel for Da Vinci Surgical System · 2024-10-24 · $340

2023: $17

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Payments by company in 2023

Medtronic	Dextile	$17	1 payment Meals for Dextile · 2023-03-24 · $17

Professional record

NPI: 1750472338
Licence: CA A63039California A63039: Current · expires 2027-03-31
Trained: University of California, San Francisco School of Medicine, 1996
Group: Sutter Bay Medical Foundation · Washington Township Medical Foundation
Gender: Male

More record details

Sole proprietor: No
Taxonomy: Surgery (208600000X)
Mailing address: 325 Distel Cir, Los Altos, CA, 94022
NPI first listed: 2006-09-27
NPI last updated: 2020-05-20
NPI record certified: 2020-05-20

This is when the NPI record was last certified, not a medical board exam.