Mark A. Antonacci, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

P4138 Issued in TX

Practice address

3551 Roger Brooke Dr
Fort Sam Houston, TX 78234-4504

Phone

(850) 687-0316

NPI assigned

Mar 20, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in TX, IL2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Legacy Urgent Care, PA

  • Urgent Care Clinic/Center
  • Frisco, TX
  • NPI 1568622272

  TX

  Medicare reassignment Care Compare group NPD
• Premier Physicians-II, P.a.

  • Urgent Care Clinic/Center
  • Woodway, TX
  • NPI 1801204656

  TX

  Medicare reassignment NPD
• 22250 Bulverde Cec Fossil Creek LLC

  • Emergency Care Clinic/Center
  • San Antonio, TX
  • NPI 1740603422
  NPD (past)
• Frisco Emergency Medicine Associates, PA

  • Emergency Care Clinic/Center
  • Frisco, TX
  • NPI 1467612176

  Emergency Medicine

  NPD (past)
• 4MD2 Physician Services of Fort Walton Beach LLC

  • Emergency Medicine Physician
  • Fort Walton Beach, FL
  • NPI 1568420735

  Emergency Medicine

  NPD (past)
• Panhandle Emergency Physicians a Div of Sacred Heart Hosp Pensacola

  • Emergency Medicine Physician
  • Pensacola, FL
  • NPI 1215948096

  Emergency Medicine

  NPD (past)

Specialty

Emergency Medicine

Education

Uniformed Services Uhs Fe Hebert School of Med, 1997

Medicare assignment

May accept Medicare assignment

Group practices

Legacy Urgent Care PA 157 clinicians

Practice addresses (Care Compare)

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

{
    "created_epoch": "1142812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733356800000",
    "number": "1083673016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "318 TRANQUIL OAK",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782603504",
            "telephone_number": "850-687-0316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3551 ROGER BROOKE DR",
            "city": "FORT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782344504",
            "telephone_number": "850-687-0316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTONACCI",
        "first_name": "MARK",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-20",
        "last_updated": "2024-12-05",
        "certification_date": "2024-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME82194",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "P4138",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "01791",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "059191709",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "059191697",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "261491000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carlos Efrain Angueira, MD
• Mirna Anguiano, CPNP
• Mary Anibuali, CRNA
• Richard Lee Anschutz, PA-C
• Janette Ansorge, OTR
• Vincent Matthew Antunez, PA-C, MPAS
• Faten Anwar, MD
• Anuli Lovett Anyachebelu, RD
• Jennifer Jean Apodaca, PA-C
• Sarah Appleton

• All providers in Fort Sam Houston, TX
• Emergency Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 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.