Mark Skousen

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

246528 Issued in AZ

Practice address

1745 W Western Dove Dr
Snowflake, AZ 85937-6185

Phone

(480) 586-0035

NPI assigned

Aug 19, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Changepoint Integrated Health 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• Changepoint Integrated Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Holbrook, AZ
  • NPI 1205877610

  AZ

  Medicare reassignment Care Compare group
• Changepoint Integrated Health

  • Mental Illness Community Based Residential Treatment Facility
  • Lakeside, AZ
  • NPI 1467783118
  Care Compare group

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

{
    "created_epoch": "1597795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597795200000",
    "number": "1013529155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1745 W WESTERN DOVE DR",
            "city": "SNOWFLAKE",
            "state": "AZ",
            "postal_code": "859376185",
            "telephone_number": "480-586-0035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1745 W WESTERN DOVE DR",
            "city": "SNOWFLAKE",
            "state": "AZ",
            "postal_code": "859376185",
            "telephone_number": "480-586-0035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKOUSEN",
        "first_name": "MARK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-19",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "246528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Don A Shumway, DPM
• Randal Jordan Shumway, DO
• Sierra Dental, P.C.
• German Antonio Sierra, DDS
• Silver Creek Senior Citizen Council
• Bethann Smith, SLP
• Snowflake Medical Center, PC
• Snowflake School District
• Snowflake Unified School District #5
• Squire Foot and Ankle PLLC

• All providers in Snowflake, AZ
• Psychiatric/Mental Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2020; 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.