Active NPI
Mark Byron MD PC
- Medical Specialty Clinic/Center
- Jesup, GA
National Provider Identifier
1063607828
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Specialty Clinic/Center
- License
- 047579
- Legal business name
- MARK BYRON MD PC
- Practice address
- 162 Memorial Dr
Jesup, GA 31545-0101 - Phone
- (912) 427-8033
- NPI assigned
- Sep 13, 2007
- Organization subpart
- Yes
- Parent organization
- MARK BYRON MD PC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mark Daniel Byron, M.D.
- Title
- MD Owner
- Phone
- (912) 427-8033
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Specialty Clinic/Center | 261QM2500X | 047579 | GA | Primary |
Addresses
Primary practice location
162 Memorial Dr
Jesup, GA 31545-0101
Mailing address
162 Memorial Dr
Jesup, GA 31545-0101
Phone (912) 427-8033
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GRP 4653 | Other | GA | MEDICARE GROUP NUMBER |
| 00833599B | Medicaid | GA |
Other names 1
- wayne urology
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111020000065 | GA | Part B Supplier - Clinic/Group Practice | 0446422265 |
Receives reassigned benefits from 1 practitioner Practice locations: Jesup, GA |
National Provider Directory
National Provider Directory- Part of
- Mark Byron MD PC
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/GDGBBD
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189641600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1296000000000",
"number": "1063607828",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "162 MEMORIAL DR",
"city": "JESUP",
"state": "GA",
"postal_code": "315450101",
"telephone_number": "912-427-8033",
"fax_number": "912-427-7565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "162 MEMORIAL DR",
"city": "JESUP",
"state": "GA",
"postal_code": "315450101",
"telephone_number": "912-427-8033"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MARK BYRON MD PC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "MARK BYRON MD PC",
"enumeration_date": "2007-09-13",
"last_updated": "2011-01-26",
"status": "A",
"authorized_official_last_name": "BYRON",
"authorized_official_first_name": "MARK",
"authorized_official_middle_name": "DANIEL",
"authorized_official_title_or_position": "MD OWNER",
"authorized_official_telephone_number": "912-427-8033",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "261QM2500X",
"taxonomy_group": "",
"desc": "Clinic/Center, Medical Specialty",
"state": "GA",
"license": "047579",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP NUMBER",
"identifier": "GRP 4653",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00833599B",
"state": "GA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "wayne urology",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Jesup, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.