NPIMap

Individual provider Active NPI

Mark W Klabo, PA-C

  • Physician Assistant
  • Valley City, ND
National Provider Identifier
1275793978
Registry record updated Jul 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PAC0391 Issued in ND
Practice address
570 Chautauqua Blvd
Valley City, ND 58072-3145
Phone
(701) 845-6400
Fax
(701) 845-6466
NPI assigned
Jun 16, 2008
Last updated
Jul 20, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2011

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 PAC0391 ND Primary

Addresses

Primary practice location

570 Chautauqua Blvd
Valley City, ND 58072-3145

Mailing address

570 Chautauqua Blvd
Valley City, ND 58072-3145
Phone (701) 845-6400

Other identifiers 1

IdentifierTypeStateIssuer
PAC0391OtherNDLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
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
I20100505000095 ND Practitioner - Physician Assistant 1759419211 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lisbon Area Health ServicesGroup PAC ID 4486562873, 9 clinicians

Practice addresses (Care Compare)

905 Main St
Lisbon, ND 58054-0353
Phone (701) 683-6400

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PAC0391NDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lisbon Area Health Services CurrentSince Apr 1, 2021 Accepting new patients
Mercy Hospital CurrentSince Feb 7, 2015 Accepting new patients
Mercy Hospital of Valley City CurrentSince Jan 1, 2025 Accepting new patients
Oakes Community Hospital CurrentSince Jan 1, 2026 Accepting new patients
Oakes Community Hospital CurrentSince Jan 1, 2026 Accepting new patients
Lisbon Area Health Services CurrentSince Aug 4, 2025 Accepting new patients
Medallus & Vacharothone LTD Physician Assistant CurrentSince Dec 28, 2024 Accepting new patients
Lisbon Area Health Services Past Accepting new patients
After Hours Medical LLC Past Accepting new patients
Carrington Health Center Past Accepting new patients
Mercy Hospital of Devils Lake Past Accepting new patients
Carrington Health Center Past Accepting new patients

Locations

3265 Solutions Ctr
Chicago, IL 60677

3276 Solutions Ctr
Chicago, IL 60677

721 1st Ave S
Ste A
Jamestown, ND 58401
Phone (701) 368-4380

1200 N 7th St
Oakes, ND 58474
Phone (701) 742-3291

570 Chautauqua Blvd
Valley City, ND 58072
Phone (701) 845-0440

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 8

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": "1213574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311120000000",
    "number": "1275793978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "570 CHAUTAUQUA BLVD",
            "city": "VALLEY CITY",
            "state": "ND",
            "postal_code": "580723145",
            "telephone_number": "701-845-6400",
            "fax_number": "701-845-6466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "570 CHAUTAUQUA BLVD",
            "city": "VALLEY CITY",
            "state": "ND",
            "postal_code": "580723145",
            "telephone_number": "701-845-6400",
            "fax_number": "701-845-6466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLABO",
        "first_name": "MARK",
        "middle_name": "W",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-16",
        "last_updated": "2011-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": "PAC0391",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PAC0391",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Valley City, ND

Sources for this page

Verify at the official NPI Registry.