NPIMap

Individual provider Active NPI

Mark Dziemianowicz, MD

  • Radiation Oncology Physician
  • Greeley, CO
National Provider Identifier
1154776029
Registry record updated Feb 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
DR0072435 Issued in CO
Practice address
1801 16TH St
Greeley, CO 80631
Phone
(970) 810-3894
Fax
(970) 810-3897
NPI assigned
Apr 28, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Radiation Oncology Physician 2085R0001X DR0072435 CO Primary
Radiation Oncology Physician 2085R0001X 13549A WY

Addresses

Primary practice location

1801 16TH St
Greeley, CO 80631

Mailing address

1801 16TH St
Greeley, CO 80631
Phone (970) 810-3894

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mdziemianowicz46775@direct.crmcwy.org Direct Memorial Hospital of Laramie County
Direct Messaging Address mdziemianowicz46775@direct.crmcwy.org Health Information Exchange (HIE) Memorial Hospital of Laramie County

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20240405002096 CO Practitioner - Radiation Oncology 3779852454 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
Temple University School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Banner Hospital Based Physicians Colorado LLCGroup PAC ID 6800031386, 82 clinicians

Practice addresses (Care Compare)

1801 16TH St
Greeley, CO 80631-5154
Phone (970) 810-4593

Hospital & facility affiliations

  • Banner North Colorado Medical Center Hospital, Greeley, CO, CCN 060001
  • Sterling Regional Medcenter Hospital, Sterling, CO, CCN 060076
  • Banner North Co Medical Center - Loveland Campus Hospital, Loveland, CO, CCN 060030
  • Uchealth Greeley Hospital Hospital, Greeley, CO, CCN 060131
  • East Morgan County Hospital Hospital, Brush, CO, CCN 061303

Merit-based Incentive Payment System (MIPS)

Final score
89.03 of 100Reported as group
Quality
81.34
Promoting interoperability
100
Improvement activities
40
Cost
76.8

Merit-based Incentive Payment System (MIPS)

Final score
87.9 of 100Reported as group
Quality
79.21
Promoting interoperability
99
Improvement activities
40
Cost
77.28

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR0072435COMDRadiation Oncology Physician
13549AWYMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Hospital Based Physicians Colorado LLC CurrentSince Apr 15, 2024 Accepting new patients
Banner Hospital Based Physicians Colorado LLC CurrentSince Apr 15, 2024 Accepting new patients
Banner Hospital Based Physicians Colorado LLC Current Accepting new patients

Locations

4700 Lady Moon Dr
Fort Collins, CO 80528
Phone (970) 521-4600

1801 16th St
Ste C2B
Greeley, CO 80631
Phone (970) 810-4121

1801 16th St
Greeley, CO 80631
Phone (970) 352-4121

2000 Boise Ave
Loveland, CO 80538
Phone (970) 635-4071

Interoperability endpoints

  • Direct secure messaging: mdziemianowicz46775@direct.crmcwy.org

Organizations & group practices 3

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 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1461801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739145600000",
    "number": "1154776029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 16TH ST",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "80631",
            "telephone_number": "970-810-3894",
            "fax_number": "970-810-3897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 16TH ST",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "80631",
            "telephone_number": "970-810-3894",
            "fax_number": "970-810-3897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DZIEMIANOWICZ",
        "first_name": "MARK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-28",
        "last_updated": "2025-02-10",
        "certification_date": "2024-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "CO",
            "license": "DR0072435",
            "primary": true
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "WY",
            "license": "13549A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mdziemianowicz46775@direct.crmcwy.org",
            "affiliation": "Y",
            "endpointDescription": "CRMC Direct Address",
            "affiliationName": "Memorial Hospital of Laramie County",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "310 E 24th St",
            "city": "Cheyenne",
            "state": "WY",
            "country_code": "US",
            "postal_code": "820013126",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mdziemianowicz46775@direct.crmcwy.org",
            "affiliation": "Y",
            "endpointDescription": "CRMC Direct Address",
            "affiliationName": "Memorial Hospital of Laramie County",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "310 E 24th St",
            "city": "Cheyenne",
            "state": "WY",
            "country_code": "US",
            "postal_code": "820013126",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greeley, CO

Sources for this page

Verify at the official NPI Registry.