NPIMap

Individual provider Active NPI

Mark Conrad Stover, MD

  • Emergency Medicine Physician
  • Kotzebue, AK
National Provider Identifier
1093876138
Registry record updated Nov 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
C55475 Issued in CA
Practice address
436 5TH Ave
Kotzebue, AK 99752
Phone
(907) 442-7148
NPI assigned
Dec 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 04-34374 KS
Emergency Medicine Physician 207P00000X C55475 CA Primary

Addresses

Primary practice location

436 5TH Ave
Kotzebue, AK 99752

Mailing address

705 N San Francisco St
Flagstaff, AZ 86001-3232

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, CA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110718000276 TX Practitioner - Emergency Medicine 4486755741 Reassigns benefits to 2 organizations
I20130718000746 CA Practitioner - Emergency Medicine 4486755741 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Washington University School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Maniilaq AssociationGroup PAC ID 6103881792, 32 clinicians

Practice addresses (Care Compare)

110 Main St
Ambler Clinic
Ambler, AK 99786-0110
Phone (907) 445-2129

436 5TH and Ted Stevens Way
Maniilaq Health Center
Kotzebue, AK 99752-0043
Phone (907) 442-3321

P O Box
Suite 43
Kotzubue, AK 99752-0043

PO Box
Suite 43
Kotzebue, AK 99752-0043

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
04-34374KSMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Maniilaq Association CurrentSince Mar 23, 2018 Accepting new patients
Cep America-California Emergency Medicine CurrentSince Jun 1, 2013 Accepting new patients
Maniilaq Association Current Accepting new patients
Tuba City Regional Health Care Corporation Family Medicine CurrentSince Dec 24, 2017 Accepting new patients
Tuba City Regional Health Care Corporation Emergency Medicine CurrentSince Dec 24, 2017 Accepting new patients
Cep America - California Emergency Medicine CurrentSince Jun 1, 2013 Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

450 Stanyan St
San Francisco, CA 94117
Phone (415) 668-1000

Interoperability endpoints

  • Direct secure messaging: mstover@direct.maniilaq.org

Organizations & group practices 6

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.

Hospital & facility affiliations 12

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": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479340800000",
    "number": "1093876138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 N SAN FRANCISCO ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860013232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "436 5TH AVE",
            "city": "KOTZEBUE",
            "state": "AK",
            "postal_code": "99752",
            "telephone_number": "907-442-7148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOVER",
        "first_name": "MARK",
        "middle_name": "CONRAD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-13",
        "last_updated": "2016-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "KS",
            "license": "04-34374",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "C55475",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kotzebue, AK

Sources for this page

Verify at the official NPI Registry.