Individual provider Active NPI

Mark Anthony Walker, PT

  • Physical Therapist
  • Conroe, TX
National Provider Identifier
1063600591
Registry record updated Mar 24, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1177289 Issued in TX
Practice address
4015 Interstate 45 N
Conroe, TX 77304-4901
Phone
(936) 522-4731
Fax
(936) 522-4737
NPI assigned
Oct 10, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1177289 TX Primary

Addresses

Primary practice location

4015 Interstate 45 N
Conroe, TX 77304-4901

Mailing address

4015 Interstate 45 N
Conroe, TX 77304-4901
Phone (936) 522-4731

Other identifiers 2

IdentifierTypeStateIssuer
00J21AOtherTXMEDICARE GROUP
1912875-01MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080108000616 TX Practitioner - Physical Therapist in Private Practice 4284714825 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

6767 Lake Woodlands Dr
The Woodlands, TX 77382-2566

Merit-based Incentive Payment System (MIPS)

Final score
81.05 of 100Reported as group
Quality
67.43
Promoting interoperability
100
Improvement activities
40
Cost
69.42

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1177289TXMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Sterling Ridge Orthopaedics and Sports Medicine, LLC CurrentSince Jun 30, 2014 Accepting new patients
Sterling Ridge Orthopaedics and Sports Medicine, LLC Current Accepting new patients

Locations

20639 Kuykendahl Rd
Ste 200
Spring, TX 77379
Phone (832) 698-0111

6767 Lake Woodlands Dr
#F
The Woodlands, TX 77382
Phone (281) 364-1122

Interoperability endpoints

  • Direct secure messaging: mark.walker.1@1066.direct.athenahealth.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1191974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269388800000",
    "number": "1063600591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4015 INTERSTATE 45 N",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773044901",
            "telephone_number": "936-522-4731",
            "fax_number": "936-522-4737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4015 INTERSTATE 45 N",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773044901",
            "telephone_number": "936-522-4731",
            "fax_number": "936-522-4737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALKER",
        "first_name": "MARK",
        "middle_name": "ANTHONY",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-10",
        "last_updated": "2010-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1177289",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "00J21A",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1912875-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conroe, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.