NPIMap

Individual provider Active NPI

Mark Leon Siebe, PA-C

  • Family Medicine Physician
  • Fort Campbell, KY
National Provider Identifier
1053801886
Registry record updated Aug 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
3649 Issued in TN
Practice address
Blanchfield Army Community Hospital
650 Joel Dr
Fort Campbell, KY 42223-5318
Phone
(270) 798-8727
NPI assigned
May 17, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Family Medicine Physician 207Q00000X 3649 TN Primary

Addresses

Primary practice location

Blanchfield Army Community Hospital
650 Joel Dr
Fort Campbell, KY 42223-5318

Mailing address

1046 Weston CT
Brentwood, TN 37027-2404
Phone (615) 630-2250

Other practice location 1

717 Shenandoah Dr
Brentwood, TN 37027-6023
Phone (615) 630-2250

Other practice location 2

2201 Murphy Ave Ste 204
Nashville, TN 37203-1952
Phone (615) 321-3511

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, KY, TX3 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 3

Enrollment IDStateProvider typePAC IDDetails
I20190401002524 TN Practitioner - Physician Assistant 3072854033 Reassigns benefits to 3 organizations
I20191226001948 KY Practitioner - Physician Assistant 3072854033
I20241125000280 TX Practitioner - Physician Assistant 3072854033 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1204 Seward Ave
Searhc 1204 Behavioral Health Sitka
Sitka, AK 99835-7359
Phone (907) 966-8611

1206 Seward Ave
Searhc 1206 Behavioral Health Sitka
Sitka, AK 99835-7359
Phone (907) 966-8611

1209 Seward Ave
Searhc 1209 Behavioral
Sitka, AK 99835-7359
Phone (907) 966-8611

222 Tongass Dr
Sitka, AK 99835-9416
Phone (907) 966-2411

227 Tongass Dr
Sitka, AK 99835-9416
Phone (907) 966-2411

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
3649TNMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medicine Services of TN, PC Physician Assistant CurrentSince Sep 26, 2025 Accepting new patients
Advanced Diagnostic Imaging, PC Physician Assistant CurrentSince Mar 1, 2019 Accepting new patients
Southeast Alaska Regional Health Consortium CurrentSince Nov 4, 2024 Accepting new patients
Advanced Diagnostic Imaging PC CurrentSince Mar 1, 2019 Accepting new patients
Southeast Alaska Regional Health Consortium CurrentSince Nov 4, 2024 Accepting new patients
Southeast Alaska Regional Health Consortium Past Accepting new patients

Locations

37 Chilkat Ave
Haines, AK 99827
Phone (907) 463-4040

3100 Channel Dr
Ste 300
Juneau, AK 99801
Phone (907) 463-4000

222 Tongass Dr
Sitka, AK 99835
Phone (907) 966-8423

5655 Frist Blvd
Hermitage, TN 37076
Phone (615) 316-3541

2201 Murphy Ave
Ste 204
Nashville, TN 37203
Phone (615) 284-7755

2300 Patterson St
Nashville, TN 37203
Phone (615) 342-1500

28 White Bridge Pike
Ste 207
Nashville, TN 37205
Phone (615) 467-4636

3443 Dickerson Pike
Ste 400
Nashville, TN 37207
Phone (615) 612-2146

Interoperability endpoints

  • Direct secure messaging: msiebe674543@direct.vumc.org

Organizations & group practices 8

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.

Hospital & facility affiliations 35

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

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1526515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598572800000",
    "number": "1053801886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1046 WESTON CT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370272404",
            "telephone_number": "615-630-2250",
            "fax_number": "615-630-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BLANCHFIELD ARMY COMMUNITY HOSPITAL",
            "address_2": "650 JOEL DR",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422235318",
            "telephone_number": "270-798-8727"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "717 Shenandoah Dr",
            "address_purpose": "LOCATION",
            "city": "Brentwood",
            "state": "TN",
            "postal_code": "370276023",
            "country_code": "US",
            "telephone_number": "615-630-2250",
            "fax_number": "615-630-2250",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2201 Murphy Ave Ste 204",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372031952",
            "country_code": "US",
            "telephone_number": "615-321-3511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIEBE",
        "first_name": "MARK",
        "middle_name": "LEON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-17",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "3649",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Campbell, KY

Sources for this page

Verify at the official NPI Registry.