NPIMap

Individual provider Active NPI

Mark Lynwood Wantz, MD

  • Family Medicine Physician
  • Summersville, WV
National Provider Identifier
1235128083
Registry record updated Apr 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
15521 Issued in WV
Practice address
350 Fairview Heights Rd
Summersville, WV 26651-1085
Phone
(304) 872-5090
Fax
(304) 872-0636
NPI assigned
Oct 14, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 15521 WV Primary

Addresses

Primary practice location

350 Fairview Heights Rd
Summersville, WV 26651-1085

Mailing address

PO Box 1029
Summersville, WV 26651-0139
Phone (304) 872-5090

Other identifiers 1

IdentifierTypeStateIssuer
0052360000MedicaidWV

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address mwantz130957@direct.wvuhsdirect.com Health Information Exchange (HIE)
Direct Messaging Address mwantz130957@direct.wvuhsdirect.com Health Information Exchange (HIE)
Direct Messaging Address mwantz130957@direct.wvuhsdirect.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
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
I20100106000414 WV Practitioner - Family Practice 8820092943 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Loma Linda University School of Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West Virginia Health Care Cooperative IncGroup PAC ID 9830431030, shared by 3 NPIs, 61 clinicians

Practice addresses (Care Compare)

350 Fairview Heights Rd
Summersville, WV 26651-9301
Phone (304) 872-5090

400 Fairview Heighs Rd
Summersville, WV 26651-9308

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.34 of 100Reported as apm
Quality
79.86
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
West Virginia Health Care Cooperative Inc Current Accepting new patients
West Virginia Health Care Cooperative Inc CurrentSince Oct 5, 2020 Accepting new patients

Locations

400 Fairview Heights Rd
Summersville, WV 26651
Phone (304) 872-2891

350 Fairview Heights Rd
Summersville, WV 26651
Phone (304) 872-5090

Interoperability endpoints

  • Direct secure messaging: mlwantz@yourcarecommunity.org

Organizations & group practices 2

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 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1129248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650499200000",
    "number": "1235128083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1029",
            "city": "SUMMERSVILLE",
            "state": "WV",
            "postal_code": "266510139",
            "telephone_number": "304-872-5090",
            "fax_number": "304-872-0636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 FAIRVIEW HEIGHTS RD",
            "city": "SUMMERSVILLE",
            "state": "WV",
            "postal_code": "266511085",
            "telephone_number": "304-872-5090",
            "fax_number": "304-872-0636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANTZ",
        "first_name": "MARK",
        "middle_name": "LYNWOOD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-14",
        "last_updated": "2022-04-21",
        "certification_date": "2022-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "15521",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0052360000",
            "state": "WV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mwantz130957@direct.wvuhsdirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "350 Fairview Heights Rd",
            "city": "Summersville",
            "state": "WV",
            "country_code": "US",
            "postal_code": "266519301",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mwantz130957@direct.wvuhsdirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "350 Fairview Heights Rd",
            "city": "Summersville",
            "state": "WV",
            "country_code": "US",
            "postal_code": "266519301",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mwantz130957@direct.wvuhsdirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "350 Fairview Heights Rd",
            "city": "Summersville",
            "state": "WV",
            "country_code": "US",
            "postal_code": "266519301",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Summersville, WV

Sources for this page

Verify at the official NPI Registry.