Mark L Modic, MD

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

049287 Issued in OH

Practice address

7255 Old Oak Blvd
Suite C412
Middleburg Heights, OH 44130-3329

Phone

(440) 816-4546

Fax

(440) 816-4549

NPI assigned

Jul 15, 2005

Last updated

Oct 4, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Westside Gastroenterologists, Inc.

  • Gastroenterology Physician
  • Middleburg Heights, OH
  • NPI 1285767673
  NPD

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

{
    "created_epoch": "1121385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349308800000",
    "number": "1336148022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7255 OLD OAK BLVD",
            "address_2": "SUITE C412",
            "city": "MIDDLEBURG HEIGHTS",
            "state": "OH",
            "postal_code": "441303329",
            "telephone_number": "440-816-4546",
            "fax_number": "440-816-4549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7255 OLD OAK BLVD",
            "address_2": "SUITE C412",
            "city": "MIDDLEBURG HEIGHTS",
            "state": "OH",
            "postal_code": "441303329",
            "telephone_number": "440-816-4546",
            "fax_number": "440-816-4549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODIC",
        "first_name": "MARK",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-15",
        "last_updated": "2012-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "OH",
            "license": "049287",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0660931",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samuel P Miranda, M.D.
• Agni Mirza, M.D.
• Kevin Misiakiewicz
• Kayla Jordan Mitchell, LPC
• Michelle Mitchell
• Laura Moncrief, PSY.D.
• Alexis Nicolette Montemarano
• Christine M. Moore, AA
• Michael John Morris, PHD IN PSYCHOLOGY
• Kierra Mosley

• Gastroenterology Physician in Middleburg Heights, OH
• Providers in Middleburg Heights, OH by specialty
• Gastroenterology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.