Active NPI
Mark Douglas Statler, M.D.
- Pediatrics Physician
- New Braunfels, TX
National Provider Identifier
1164475604
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- G3815
- Practice address
- 1535 E Common St
New Braunfels, TX 78130-3154 - Phone
- (830) 625-9153
- NPI assigned
- May 18, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | G3815 | TX | Primary |
Addresses
Primary practice location
1535 E Common St
New Braunfels, TX 78130-3154
Mailing address
1535 Common St
New Braunfels, TX 78130-3154
Phone (830) 625-9153
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 121490001 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G3815 | TX | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312329600000",
"number": "1164475604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1535 COMMON ST",
"city": "NEW BRAUNFELS",
"state": "TX",
"postal_code": "781303154",
"telephone_number": "830-625-9153"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1535 E COMMON ST",
"city": "NEW BRAUNFELS",
"state": "TX",
"postal_code": "781303154",
"telephone_number": "830-625-9153"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STATLER",
"first_name": "MARK",
"middle_name": "DOUGLAS",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-18",
"last_updated": "2011-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "G3815",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "121490001",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in New Braunfels, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.