Mark Shane Bickley, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

H6051 Issued in TX

Practice address

2900 Denton Hwy Ste a
Haltom City, TX 76117-3763

Phone

(817) 831-2012

Fax

(817) 831-0134

NPI assigned

Aug 18, 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

Medicare fee-for-service enrollment

Enrolled in HI

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445472000000",
    "number": "1194839290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 DENTON HWY STE A",
            "city": "HALTOM CITY",
            "state": "TX",
            "postal_code": "761173763",
            "telephone_number": "817-831-2012",
            "fax_number": "817-831-0134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 DENTON HWY STE A",
            "city": "HALTOM CITY",
            "state": "TX",
            "postal_code": "761173763",
            "telephone_number": "817-831-2012",
            "fax_number": "817-831-0134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BICKLEY",
        "first_name": "MARK",
        "middle_name": "SHANE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-18",
        "last_updated": "2015-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "H6051",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "HI",
            "license": "1671",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Haltom City, TX
• Providers in Haltom City, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.