NPIMap

Individual provider Active NPI

Mark D Eden, MD

  • Family Medicine Physician
  • Fredericksburg, TX
National Provider Identifier
1275528119
Registry record updated Jan 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
H6187 Issued in TX
Practice address
820 Reuben St Ste B
Fredericksburg, TX 78624-4583
Phone
(830) 997-9497
Fax
(830) 997-5677
NPI assigned
Sep 16, 2005
Last updated
Jan 14, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 14, 2016

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 H6187 TX Primary

Addresses

Primary practice location

820 Reuben St Ste B
Fredericksburg, TX 78624-4583

Mailing address

820 Reuben St Ste B
Fredericksburg, TX 78624-4583
Phone (830) 997-9497

Other identifiers 2

IdentifierTypeStateIssuer
8EH989OtherTXBCBSTX
337166801MedicaidTX

Other names 1

  • Mark D Eden Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20041129000095 TX Practitioner - Family Practice 8628033966 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Baylor College of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

205 W Windcrest St
Suite 250
Fredericksburg, TX 78624-4478

820 Reuben St
Suite B
Fredericksburg, TX 78624-4583
Phone (830) 997-9497

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
57.78 of 100Reported as individual
Quality
90
Improvement activities
0
Cost
72.61

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions62
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mark D Eden MD PA Family Medicine CurrentSince May 15, 1991 Accepting new patients
Fredericksburg Family Clinic PA Family Medicine Past Accepting new patients
Fredericksburg Family Clinic PA Family Medicine Past Accepting new patients
Karen G Cornett MD PA Family Medicine Past Accepting new patients

Locations

820 Reuben St
Ste B
Fredericksburg, TX 78624
Phone (830) 997-3038

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1126828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452729600000",
    "number": "1275528119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 REUBEN ST STE B",
            "city": "FREDERICKSBURG",
            "state": "TX",
            "postal_code": "786244583",
            "telephone_number": "830-997-9497",
            "fax_number": "830-997-5677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 REUBEN ST STE B",
            "city": "FREDERICKSBURG",
            "state": "TX",
            "postal_code": "786244583",
            "telephone_number": "830-997-9497",
            "fax_number": "830-997-5677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDEN",
        "first_name": "MARK",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-16",
        "last_updated": "2016-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "H6187",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSTX",
            "identifier": "8EH989",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "337166801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARK",
            "last_name": "EDEN",
            "middle_name": "D",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Fredericksburg, TX

Sources for this page

Verify at the official NPI Registry.