NPIMap

Individual provider Active NPI

Mark Fredric Abbott, M.D.

  • Vascular & Interventional Radiology Physician
  • Pueblo, CO
National Provider Identifier
1295993871
Registry record updated Apr 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
DR.0056380 Issued in CO
Practice address
1619 N Greenwood St Ste 103
Pueblo, CO 81003-2655
Phone
(719) 542-2167
NPI assigned
May 29, 2008
Last updated
Apr 22, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 149032 NC
Diagnostic Radiology Physician 2085R0202X 8495680-1205 UT
Vascular & Interventional Radiology Physician 2085R0204X 8495680-1205 UT
Vascular & Interventional Radiology Physician 2085R0204X DR.0056380 CO Primary

Addresses

Primary practice location

1619 N Greenwood St Ste 103
Pueblo, CO 81003-2655

Mailing address

1619 N Greenwood St Ste 103
Pueblo, CO 81003-2655
Phone (719) 542-2167

Other practice location 1

1200 E 3900 S
ATTN: Radiology Department
Salt Lake City, UT 84124-1300
Phone (801) 298-1300

Other identifiers 9

IdentifierTypeStateIssuer
10000009999001OtherUTBCBSU
107120161102OtherUTSELECTHEALTH
1295993871MedicaidUT
4697935OtherUTAETNA HEALTHCARE
P01180702OtherUTRAILROAD MEDICARE
1295993871OtherUTEMI HEALTH
1137616OtherUTDMBA
1295993871OtherUTMOLINA HEALTHCARE
145448OtherUTPEHP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, CO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130522000528 UT Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 3173761681
I20160516002355 CO Practitioner - Diagnostic Radiology 3173761681 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Iowa, RJ & L Carver College of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern Colorado Radiologists, P.C.Group PAC ID 7517959794, 11 clinicians
Parkwest Imaging, L.L.CGroup PAC ID 3173415247, 11 clinicians

Practice addresses (Care Compare)

1619 N Greenwood St
Suite 103
Pueblo, CO 81003-2655
Phone (719) 542-2167

3676 Parker Blvd
Suite 165
Pueblo, CO 81008-2212
Phone (719) 595-7600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
149032NCMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Colorado Radiologists, P.C. CurrentSince Jul 1, 2016 Accepting new patients
Parkwest Imaging, L.L.C Diagnostic Radiology CurrentSince Jul 1, 2016 Accepting new patients
West Valley Imaging LLC Diagnostic Radiology Past Accepting new patients
Radiology Associates Diagnostic Radiology PastSince Jul 1, 2016 Accepting new patients
Ogden Imaging LLC Diagnostic Radiology Past Accepting new patients

Locations

1619 N Greenwood St
Ste 103
Pueblo, CO 81003
Phone (719) 542-2167

3676 Parker Blvd
Ste 165
Pueblo, CO 81008
Phone (719) 253-7040

Organizations & group practices 5

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 54

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

View all 54

NPI Registry JSON

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

{
    "created_epoch": "1212019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745280000000",
    "number": "1295993871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1619 N GREENWOOD ST STE 103",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032655",
            "telephone_number": "719-542-2167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1619 N GREENWOOD ST STE 103",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032655",
            "telephone_number": "719-542-2167"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 E 3900 S",
            "address_2": "ATTN: Radiology Department",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841241300",
            "country_code": "US",
            "telephone_number": "801-298-1300",
            "fax_number": "801-296-6199",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ABBOTT",
        "first_name": "MARK",
        "middle_name": "FREDRIC",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-29",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "149032",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "UT",
            "license": "8495680-1205",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "UT",
            "license": "8495680-1205",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "CO",
            "license": "DR.0056380",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSU",
            "identifier": "10000009999001",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SELECTHEALTH",
            "identifier": "107120161102",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295993871",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HEALTHCARE",
            "identifier": "4697935",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01180702",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMI HEALTH",
            "identifier": "1295993871",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMBA",
            "identifier": "1137616",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOLINA HEALTHCARE",
            "identifier": "1295993871",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEHP",
            "identifier": "145448",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.