Mark W Bookout, M.D.

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

011511 Issued in TN

Practice address

4151 Ringgold Rd
East Ridge, TN 37412-2434

Phone

(423) 622-5165

Fax

(423) 622-5167

NPI assigned

Oct 7, 2005

Last updated

Dec 10, 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 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: mbookout17035@direct.erlanger.org

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

{
    "created_epoch": "1128643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355097600000",
    "number": "1356339063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6918 SHALLOWFORD RD",
            "address_2": "SUITE 206",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374216784",
            "telephone_number": "423-855-2552",
            "fax_number": "423-855-9041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4151 RINGGOLD RD",
            "city": "EAST RIDGE",
            "state": "TN",
            "postal_code": "374122434",
            "telephone_number": "423-622-5165",
            "fax_number": "423-622-5167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOKOUT",
        "first_name": "MARK",
        "middle_name": "W",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-07",
        "last_updated": "2012-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "TN",
            "license": "011511",
            "primary": true
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "GA",
            "license": "025947",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000282125B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3021453",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madison Christine Bankston, PT
• Ray Gene Belanger, ATC
• Benchmark Healthcare Services LLC
• Patricia Diane Blasick, PA
• Judith J Boggess, M.D.
• Jessica Briscoe
• David Grant Brogdon, D.C.
• Alex Bryant
• BSK Enterprises, LLC (Southern Heritage Assisted Living II)
• Evelyne Vanitha Burtis, MSPT

• Otolaryngology Physician in East Ridge, TN
• Providers in East Ridge, TN by specialty
• Otolaryngology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.