NPIMap

Individual provider Active NPI

Mark D. Williams, PA-C

  • Physician Assistant
  • Salem, OR
National Provider Identifier
1255369765
Registry record updated Jul 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA00623 Issued in OR
Practice address
1793 13TH St SE
Salem, OR 97302-2541
Phone
(503) 362-8385
Fax
(503) 362-8435
NPI assigned
Jun 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA00623 OR Primary

Addresses

Primary practice location

1793 13TH St SE
Salem, OR 97302-2541

Mailing address

1793 13TH St SE
Salem, OR 97302-2541
Phone (503) 362-8385

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20040826000725 OR Practitioner - Physician Assistant 0547235392 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Silver Falls Dermatology LLCGroup PAC ID 5890863492, 100 clinicians

Practice addresses (Care Compare)

1390 Waverly Dr SE
Albany, OR 97322-6945
Phone (503) 362-8385

2358 NW Kings Blvd
Suite 100
Corvallis, OR 97330-3925
Phone (503) 362-8385

Hospital & facility affiliations

  • Samaritan Pacific Community Hospital Hospital, Newport, OR, CCN 381314
  • Samaritan Lebanon Community Hospital Hospital, Lebanon, OR, CCN 381323
  • Samaritan Albany General Hospital Hospital, Albany, OR, CCN 380022

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA00623ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Silver Falls Dermatology, LLC Physician Assistant CurrentSince Oct 1, 2008 Accepting new patients
Good Samaritan Hospital Corvallis Past Accepting new patients
Firstcare Medical Foundation Physician Assistant PastSince Sep 1, 2004 Accepting new patients

Locations

1390 Waverly Dr SE
Ste 100
Albany, OR 97322

1390 Waverly Dr SE
Albany, OR 97322
Phone (541) 967-8385

2358 NW Kings Blvd
Ste 100
Corvallis, OR 97330
Phone (541) 368-5986

3132 State St
Ste 110
Medford, OR 97504
Phone (541) 732-1686

904 SW Bay St
Newport, OR 97365
Phone (541) 683-2020

1793 13th St SE
Salem, OR 97302
Phone 50336283851283

1430 Commercial St SE
Salem, OR 97302
Phone (503) 362-9033

Interoperability endpoints

  • Direct secure messaging: markwilliams@frontierdermpartners.emadirect.md

Organizations & group practices 3

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 45

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

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436745600000",
    "number": "1255369765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1793 13TH ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973022541",
            "telephone_number": "503-362-8385",
            "fax_number": "503-362-8435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1793 13TH ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973022541",
            "telephone_number": "503-362-8385",
            "fax_number": "503-362-8435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "MARK",
        "middle_name": "D.",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-30",
        "last_updated": "2015-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA00623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

Verify at the official NPI Registry.