Active NPI
Mark D. King, M.D.
- Family Medicine Physician
- Kirkwood, MO
National Provider Identifier
1306866496
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- R1P80
- Practice address
- 455 S Kirkwood Rd
Kirkwood, MO 63122-6119 - Phone
- (636) 256-8644
- NPI assigned
- Jul 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R1P80 | MO | Primary |
Addresses
Primary practice location
455 S Kirkwood Rd
Kirkwood, MO 63122-6119
Mailing address
17505 Summit View Place RDG
Wildwood, MO 63038-2105
Phone (636) 458-6285
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00348648 | Other | MO | RR MEDICARE |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R1P80 | MO | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physician Specialists of St Lukes LLC | Family Medicine | Past | Accepting new patients |
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.
-
- Internal Medicine Physician
- Chesterfield, MO
- NPI 1235168410
Family Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265673600000",
"number": "1306866496",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17505 SUMMIT VIEW PLACE RDG",
"city": "WILDWOOD",
"state": "MO",
"postal_code": "630382105",
"telephone_number": "636-458-6285"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "455 S KIRKWOOD RD",
"city": "KIRKWOOD",
"state": "MO",
"postal_code": "631226119",
"telephone_number": "636-256-8644"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KING",
"first_name": "MARK",
"middle_name": "D.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-20",
"last_updated": "2010-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "R1P80",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00348648",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kirkwood, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.