Mark Bruckel Elliot, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

218113 Issued in MA

Practice address

48 Main St
Stockbridge, MA 01262-0962

Phone

(413) 551-7925

Fax

(413) 728-5580

NPI assigned

Dec 5, 2005

Last updated

Dec 17, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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 MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Georgetown University School of Medicine, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Berkshire Psychodynamic Psychiatry Inc

  • Psychiatry Physician
  • Stockbridge, MA
  • NPI 1801280391
  Medicare reassignment NPD Authorized official
• Rhode Island Hospital

  • General Acute Care Hospital
  • Providence, RI
  • NPI 1972768174
  NPD (past)
• The Providence Center

  • Community/Behavioral Health Agency
  • Providence, RI
  • NPI 1134977598

  Psychiatry

  NPD (past)
• The Providence Center Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Providence, RI
  • NPI 1104847946

  Psychiatry

  NPD (past)

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

{
    "created_epoch": "1133740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734393600000",
    "number": "1073597845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 962",
            "city": "STOCKBRIDGE",
            "state": "MA",
            "postal_code": "012620962",
            "telephone_number": "413-551-7925",
            "fax_number": "413-728-5580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 MAIN ST",
            "city": "STOCKBRIDGE",
            "state": "MA",
            "postal_code": "012620962",
            "telephone_number": "413-551-7925",
            "fax_number": "413-728-5580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIOT",
        "first_name": "MARK",
        "middle_name": "BRUCKEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-05",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "218113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary Lee Delair, DDS
• Sandra Delgado, PSY.D
• Elaine Virginia Demos, EDD
• Jennifer Anne Durham-Fowler, PH.D.
• Robert Joseph Edwards, DDS
• Donna M Elmendorf, PHD
• Erin Seery LLC
• Elizabeth Fedotowsky, RNC CADAC
• James Christopher Fowler, PHD
• Milton Gerard Fromm, PH.D.

• Psychiatry Physician in Stockbridge, MA
• Providers in Stockbridge, MA by specialty
• Psychiatry Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; 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.