NPIMap

Individual provider Active NPI

Mark J. Walterskirchen, M.D.

  • Urology Physician
  • Springfield, MO
National Provider Identifier
1083637524
Registry record updated Jan 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
MD00048487 Issued in WA
Practice address
1965 S Fremont Ave
Suite 370
Springfield, MO 65804-2201
Phone
(417) 820-0300
Fax
(417) 882-9645
NPI assigned
Jul 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 2000155025 MO
Urology Physician 208800000X MD00048487 WA Primary

Addresses

Primary practice location

1965 S Fremont Ave
Suite 370
Springfield, MO 65804-2201

Mailing address

PO Box 2580
Springfield, MO 65801-2580
Phone (417) 829-4620

Other identifiers 3

IdentifierTypeStateIssuer
340017773OtherMORR MEDICARE PROV. #
1083637524OtherMONPI #
204964605MedicaidMO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060816000134 MO Practitioner - UrologyPractitioner - Internal Medicine 2466455308 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
UrologyAlso: Internal Medicine
Education
University of Washington School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Citizens Memorial HealthcareGroup PAC ID 4183528169, 144 clinicians

Practice addresses (Care Compare)

Bolivar, MO 65613
Phone (417) 328-6631

1155 W Parkview
Bolivar, MO 65613-7800

1155 W Parkview St
Bolivar, MO 65613-7800

1500 N Oakland Ave
CMH Diabetes
Bolivar, MO 65613-3099
Phone (417) 328-6040

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection14

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2000155025MOMDUrology Physician
MD00048487WAMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Citizens Memorial Healthcare CurrentSince Jan 4, 2021 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Sep 1, 2000 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Jan 18, 2010 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Sep 1, 2000 Accepting new patients
Citizens Memorial Healthcare CurrentSince Jan 4, 2021 Accepting new patients
Urology Clinic PC Urology Past Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

1155 W Parkview St
Ste 2C
Bolivar, MO 65613
Phone (417) 326-2550

1500 N Oakland Ave
Bolivar, MO 65613
Phone (417) 326-6000

1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

1965 S Fremont Ave
Ste 370
Springfield, MO 65804
Phone (417) 820-0300

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

Interoperability endpoints

  • Direct secure messaging: mwalterskirchen1151@directb.mercy.net

Organizations & group practices 7

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 10

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": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768435200000",
    "number": "1083637524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2580",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658012580",
            "telephone_number": "417-829-4620",
            "fax_number": "417-829-4316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1965 S FREMONT AVE",
            "address_2": "SUITE 370",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042201",
            "telephone_number": "417-820-0300",
            "fax_number": "417-882-9645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERSKIRCHEN",
        "first_name": "MARK",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2026-01-15",
        "certification_date": "2026-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MO",
            "license": "2000155025",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "WA",
            "license": "MD00048487",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PROV. #",
            "identifier": "340017773",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI #",
            "identifier": "1083637524",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "204964605",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.