Mark Edward Wilbur, PAC
Individual provider Active NPI Medical Physician Assistant · Caliente, NV
NPI 1144394693 · NPPES record last updated Jan 23, 2020
Key facts
- NPI
- 1144394693
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- PA854 (NV)
- Practice address
- 700 North Spring
Caliente, NV 89008-1010 - Phone
- (775) 726-3121
- Fax
- (775) 726-3666
- NPI assigned
- Nov 17, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
502 Duckwater Falls Rd
Duckwater, NV 89314-9800
PO Box
Suite 140087
Duckwater, NV 89314-0087
Hospital & facility affiliations
- William Bee Ririe Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NV, TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050419001290 | NV | Practitioner - Physician Assistant | 2062450125 | Reassigns benefits to 1 organization |
| I20101222000038 | TX | Practitioner - Physician Assistant | 2062450125 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4305 | AZ | MD | Hearing Instrument Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lincoln County Hospital District | Current |
Accepting new patients | |
| Lincoln County Hospital District | Current |
Accepting new patients | |
| Tuba City Regional Health Care Corporation | Current |
Accepting new patients | |
| Duckwater Health Clinic | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA854 | NV | Yes |
Addresses
Primary practice location
700 North Spring
Caliente, NV 89008-1010
Mailing address
PO Box 1010
700 North Spring
Caliente, NV 89008-1010
Phone (775) 726-3121
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100506761 | Medicaid | NV |
Other providers in Caliente, NV
All providers in Caliente, NV · Medical Physician Assistant in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 23, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.