NPIMap

Individual provider Active NPI

Mark Allen Wallingford, MD

  • Internal Medicine Physician
  • Maysville, KY
National Provider Identifier
1205919875
Registry record updated Jan 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
24430 Issued in KY
Practice address
2009 Old Main Street
Maysville, KY 41056
Phone
(606) 759-7615
Fax
(606) 759-7821
NPI assigned
Oct 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 24430 KY Primary
Pediatrics Physician 208000000X 24430 KY

Addresses

Primary practice location

2009 Old Main Street
Maysville, KY 41056

Mailing address

2009 Old Main Street
Maysville, KY 41056
Phone (606) 759-7615

Other identifiers 1

IdentifierTypeStateIssuer
64244304MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20101015000896 KY Practitioner - Internal MedicinePractitioner - Pediatric Medicine 4587638721 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
University of Kentucky College of Medicine, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2009 Old Main St
Maysville, KY 41056-8928
Phone (606) 759-7615

991 Medical Dr
Suite 207
Maysville, KY 41056-8728
Phone (606) 759-4852

991 Medical Park Dr
Maysville, KY 41056-8728

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Meadowview Physician Practice LLC CurrentSince Jun 25, 2013 Accepting new patients
Meadowview Physician Practice LLC CurrentSince Jun 25, 2013 Accepting new patients
Southeastern Physician Services PC Internal Medicine CurrentSince Apr 1, 2019 Accepting new patients
Meadowview Physician Practice, LLC Internal Medicine Current Accepting new patients
Meadowview Physician Practice LLC Internal Medicine Past Accepting new patients

Locations

310 S Limestone
Lexington, KY 40508
Phone (606) 252-6612

2009 Old Main St
Maysville, KY 41056
Phone (606) 759-7615

991 Medical Park Dr
Ste 201
Maysville, KY 41056
Phone (606) 759-3585

991 Medical Park Dr
Ste 202
Maysville, KY 41056
Phone (606) 759-5424

360 Amsden Ave
Versailles, KY 40383
Phone (606) 873-3111

Interoperability endpoints

  • Direct secure messaging: mark.wallingford.1@19475.direct.athenahealth.com

Organizations & group practices 5

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 8

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

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485734400000",
    "number": "1205919875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2009 OLD MAIN STREET",
            "city": "MAYSVILLE",
            "state": "KY",
            "postal_code": "41056",
            "telephone_number": "606-759-7615",
            "fax_number": "606-759-7821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2009 OLD MAIN STREET",
            "city": "MAYSVILLE",
            "state": "KY",
            "postal_code": "41056",
            "telephone_number": "606-759-7615",
            "fax_number": "606-759-7821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLINGFORD",
        "first_name": "MARK",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2017-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "24430",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "24430",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64244304",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maysville, KY

Sources for this page

Verify at the official NPI Registry.