NPIMap

Individual provider Active NPI

Mark Robert Forrest, MD

  • Urology Physician
  • Durango, CO
National Provider Identifier
1265469340
Registry record updated Jul 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
41391 Issued in CO
Practice address
575 River Gate Lane
#209
Durango, CO 81301
Phone
(970) 259-0440
Fax
(970) 259-7091
NPI assigned
Jun 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 41391 CO Primary

Addresses

Primary practice location

575 River Gate Lane
#209
Durango, CO 81301

Mailing address

575 River Gate Lane
#209
Durango, CO 81301
Phone (970) 259-0440

Other identifiers 1

IdentifierTypeStateIssuer
94430837MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20100817001480 CO Practitioner - Urology 1951435585 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of California, Irvine, California College of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Rivergate Orthopedics and Animas Urology PCGroup PAC ID 3971826975, 2 clinicians

Practice addresses (Care Compare)

555 Rivergate LN
Durango, CO 81301-7470
Phone (970) 247-0508

Hospital & facility affiliations

  • Mercy Regional Medical Center Hospital, Durango, CO, CCN 060013
  • Southwest Memorial Hospital Hospital, Cortez, CO, CCN 061327
  • Pagosa Springs Medical Center Hospital, Pagosa Springs, CO, CCN 061328
  • San Juan Regional Medical Center Inc Hospital, Farmington, NM, CCN 320005

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
41391COMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rivergate Orthopedics and Animas Urology, PC Urology CurrentSince Dec 1, 2014 Accepting new patients

Locations

555 Rivergate Ln
Ste B1-106
Durango, CO 81301
Phone (856) 979-7566

575 Rivergate Ln
Unit 209
Durango, CO 81301
Phone (970) 259-0440

575 Rivergate Ln
Ste 209
Durango, CO 81301
Phone (970) 259-0440

555 Rivergate Ln
#B1
Durango, CO 81301
Phone (970) 247-0508

Organizations & group practices 1

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 10

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": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217462400000",
    "number": "1265469340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 RIVER GATE LANE",
            "address_2": "#209",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "81301",
            "telephone_number": "970-259-0440",
            "fax_number": "970-259-7091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 RIVER GATE LANE",
            "address_2": "#209",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "81301",
            "telephone_number": "970-259-0440",
            "fax_number": "970-259-7091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORREST",
        "first_name": "MARK",
        "middle_name": "ROBERT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2008-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CO",
            "license": "41391",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "94430837",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Durango, CO

Sources for this page

Verify at the official NPI Registry.