NPIMap

Individual provider Active NPI

Mark Edward McMellen, M.D.

  • Surgery Physician
  • Lakewood, CO
National Provider Identifier
1053597955
Registry record updated Nov 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
2009012459 Issued in MO
Practice address
11600 W Second PL
Trauma Dept.
Lakewood, CO 80228
Phone
(314) 251-6440
Fax
(314) 251-4456
NPI assigned
Jan 10, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 30, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Critical Care Physician 2086S0102X 2009012459 MO
Surgery Physician 208600000X 2009012459 MO Primary

Addresses

Primary practice location

11600 W Second PL
Trauma Dept.
Lakewood, CO 80228

Mailing address

11600 W Second PL
Trauma Dept.
Lakewood, CO 80228
Phone (314) 251-6440

Other practice location 1

3635 Vista Ave
Dept. of Surgery
Saint Louis, MO 63110-2539
Phone (314) 577-8317 ext. 2

Other identifiers 1

IdentifierTypeStateIssuer
1053597955MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, CO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160714001802 MO Practitioner - General Surgery 2769784214 Reassigns benefits to 1 organization
I20200629002219 CO Practitioner - General Surgery 2769784214 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

11600 W 2ND PL
Lakewood, CO 80228-1527
Phone (720) 473-7120

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2009012459MOMDSurgical Critical Care Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospitals East Communities CurrentSince Aug 1, 2016 Accepting new patients
Acute Care Surgery Medical Group, Inc. Surgery CurrentSince Nov 15, 2022 Accepting new patients
Mercy Hospitals East Communities CurrentSince Aug 1, 2016 Accepting new patients
Acute Care Surgery Medical Group, Inc. Surgery CurrentSince Nov 15, 2022 Accepting new patients
Catholic Health Initiatives Colorado Past Accepting new patients

Locations

11600 W 2nd Pl
Lakewood, CO 80228
Phone (720) 321-1010

11750 W 2nd Pl
Ste 360
Lakewood, CO 80228
Phone (720) 321-8470

615 S New Ballas Rd
Saint Louis, MO 63141
Phone (314) 251-4687

621 S New Ballas Rd
Ste 560A
Saint Louis, MO 63141
Phone (314) 251-6440

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1199923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669766400000",
    "number": "1053597955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11600 W SECOND PL",
            "address_2": "TRAUMA DEPT.",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "80228",
            "telephone_number": "314-251-6440",
            "fax_number": "314-251-4456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11600 W SECOND PL",
            "address_2": "TRAUMA DEPT.",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "80228",
            "telephone_number": "314-251-6440",
            "fax_number": "314-251-4456"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3635 Vista Ave",
            "address_2": "Dept. of Surgery",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631102539",
            "country_code": "US",
            "telephone_number": "314-577-8317 x2",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCMELLEN",
        "first_name": "MARK",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-01-10",
        "last_updated": "2022-11-30",
        "certification_date": "2022-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "MO",
            "license": "2009012459",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MO",
            "license": "2009012459",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053597955",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, CO

Sources for this page

Verify at the official NPI Registry.