Active NPI
Mark Terrance Phillips
- Endodontics
- Anoka, MN
National Provider Identifier
1245403211
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- D12534
- Practice address
- 4024 8TH LN
Anoka, MN 55303-1251 - Phone
- (507) 386-0288
- NPI assigned
- Apr 10, 2008
- Last updated
- Aug 15, 2012
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | D12534 | MN | Primary |
Addresses
Primary practice location
4024 8TH LN
Anoka, MN 55303-1251
Mailing address
4024 8TH LN
Anoka, MN 55303-1251
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151222000047 | MN | Order and Referring Only - Other (Non-Physician) | 1355589102 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344988800000",
"number": "1245403211",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4024 8TH LN",
"city": "ANOKA",
"state": "MN",
"postal_code": "553031251"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4024 8TH LN",
"city": "ANOKA",
"state": "MN",
"postal_code": "553031251",
"telephone_number": "507-386-0288"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "MARK",
"middle_name": "TERRANCE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-04-10",
"last_updated": "2012-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "MN",
"license": "D12534",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anoka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2012; 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.