Active NPI
Mark E Mason, MD
- Oral & Maxillofacial Surgery (D.M.D.)
- Southlake, TX
National Provider Identifier
1255414272
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral & Maxillofacial Surgery (D.M.D.)
- License
- J4330
- Practice address
- 900 E Southlake Blvd
Ste 100
Southlake, TX 76092-6375 - Phone
- (817) 442-8900
- Fax
- (817) 488-2490
- NPI assigned
- Oct 23, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral & Maxillofacial Surgery (D.M.D.) | 204E00000X | J4330 | TX | Primary |
| Plastic Surgery Physician | 208200000X | J4330 | TX |
Addresses
Primary practice location
900 E Southlake Blvd
Ste 100
Southlake, TX 76092-6375
Mailing address
900 E Southlake Blvd
Ste 100
Southlake, TX 76092-6375
Phone (817) 442-8900
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 095081802 | Medicaid | TX | |
| 7979112 | Other | TX | AETNA PIN |
| 104535302 | Medicaid | TX | |
| 118704100 | Other | TX | FIRSTCARE PIN |
| 1210606 | Other | TX | FIRSTHEALTH PIN |
| 10028366 | Other | TX | AMERIGROUP PIN |
| 124156 | Other | TX | SUPERIOR PIN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326240000000",
"number": "1255414272",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 E SOUTHLAKE BLVD",
"address_2": "STE 100",
"city": "SOUTHLAKE",
"state": "TX",
"postal_code": "760926375",
"telephone_number": "817-442-8900",
"fax_number": "817-488-2490"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 E SOUTHLAKE BLVD",
"address_2": "STE 100",
"city": "SOUTHLAKE",
"state": "TX",
"postal_code": "760926375",
"telephone_number": "817-442-8900",
"fax_number": "817-488-2490"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MASON",
"first_name": "MARK",
"middle_name": "E",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-23",
"last_updated": "2012-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "204E00000X",
"taxonomy_group": "",
"desc": "Oral & Maxillofacial Surgery",
"state": "TX",
"license": "J4330",
"primary": true
},
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "TX",
"license": "J4330",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "095081802",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PIN",
"identifier": "7979112",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "104535302",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRSTCARE PIN",
"identifier": "118704100",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRSTHEALTH PIN",
"identifier": "1210606",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIGROUP PIN",
"identifier": "10028366",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SUPERIOR PIN",
"identifier": "124156",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southlake, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.