Mark Douglas Suprock, MD

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

200601156 Issued in NC

Practice address

10315 Hamptons Park Dr
Huntersville, NC 28078-7217

Phone

(704) 323-2800

NPI assigned

Jul 25, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Orthocarolina

  • Orthopaedic Surgery Physician
  • Charlotte, NC
  • NPI 1104843978
  NPD (past)
• Orthocarolina

  • Orthopaedic Surgery Physician
  • Huntersville, NC
  • NPI 1861419764
  NPD (past)
• Lake Erie Orthopaedics LLC

  • Specialist
  • Erie, PA
  • NPI 1780721332
  NPD (past)
• Orthopaedic & Sports Medicine of Erie, PC

  • Orthopaedic Surgery Physician
  • Erie, PA
  • NPI 1760444624
  NPD (past)
• Regional Health Services Inc

  • Family Medicine Physician
  • Erie, PA
  • NPI 1174520654
  NPD (past)

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640217600000",
    "number": "1205858339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 PARK RD",
            "address_2": "STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282093239",
            "telephone_number": "704-323-2237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10315 HAMPTONS PARK DR",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280787217",
            "telephone_number": "704-323-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPROCK",
        "first_name": "MARK",
        "middle_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2021-12-23",
        "certification_date": "2021-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NC",
            "license": "200601156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N01150",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1205858339",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elena Sukhenko, NP
• Ashley Sullivan
• Janelle Sullivan
• Summer E. Belk, DPT, Inc
• Lori Agan Sumner, PA
• Surgical Specialists of Charlotte, PA-Huntersville
• Melissa Marie Switek, LCMHC
• Hayley Caroline Amanda Sykes, LCSWA
• Synergie of Wellness L3C
• SZL Mothers Assistance Inc

• Orthopaedic Surgery Physician in Huntersville, NC
• Providers in Huntersville, NC by specialty
• Orthopaedic Surgery Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.