NPIMap

Individual provider Active NPI

Mark Bradley Fisher, M.D.

  • Urology Physician
  • Longmont, CO
National Provider Identifier
1356529028
Registry record updated Apr 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
054743 Issued in CO
Practice address
1925 Mountain View Ave
Longmont, CO 80501-3128
Phone
(720) 718-8305
Fax
(303) 485-3377
NPI assigned
Feb 5, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 036122470 IL
Urology Physician 208800000X 054743 CO Primary

Addresses

Primary practice location

1925 Mountain View Ave
Longmont, CO 80501-3128

Mailing address

1925 Mountain View Ave
Longmont, CO 80501-3128
Phone (720) 718-8305

Other identifiers 3

IdentifierTypeStateIssuer
036122470MedicaidIL
025542OtherCOKAISER COMMERCIAL NUMBER
61402516MedicaidCO

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, SD2 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
I20150324001946 CO Practitioner - Urology 0840368361 Reassigns benefits to 2 organizations
I20260216001161 SD Practitioner - Urology 0840368361 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Wayne State University School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians
Monument Health Rapid City Hospital IncGroup PAC ID 6002729506, 560 clinicians

Practice addresses (Care Compare)

1925 Mountain View Ave
Longmont, CO 80501-3128
Phone (303) 776-1234

2805 5TH St
Rapid City, SD 57701-6003
Phone (605) 755-5700

Hospital & facility affiliations

  • Monument Health Rapid City Hospital Hospital, Rapid City, SD, CCN 430077
  • Longs Peak Hospital Hospital, Longmont, CO, CCN 060128
  • Uchealth Broomfield Hospital Hospital, Broomfield, CO, CCN 060129
  • Medical Center of the Rockies Hospital, Loveland, CO, CCN 060119
  • University of Colorado Hospital Authority Hospital, Aurora, CO, CCN 060024

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
054743COMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Monument Health Rapid City Hospital Inc CurrentSince Dec 20, 2025 Accepting new patients
Poudre Valley Medical Group, LLC Urology CurrentSince May 2, 2022 Accepting new patients
Monument Health Rapid City Hospital, Inc. CurrentSince Dec 20, 2025 Accepting new patients
Rocky Mountain Lithotripter LLC Urology CurrentSince May 1, 2022 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince May 2, 2022 Accepting new patients
Monument Health Rapid City Hospital, Inc. Past Accepting new patients

Locations

340 E 1st Ave
Ste 101
Broomfield, CO 80020
Phone (303) 544-3800

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

8890 N Union Blvd
Colorado Springs, CO 80920
Phone (719) 364-5633

3535 S Lafayette St
Ste 220
Englewood, CO 80113
Phone (303) 839-6060

1925 Mountain View Ave
Longmont, CO 80501
Phone (303) 776-1234

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

2805 5th St
Rapid City, SD 57701
Phone (605) 719-5650

353 Fairmont Blvd
Rapid City, SD 57701
Phone (605) 719-1000

Organizations & group practices 7

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.

Hospital & facility affiliations 44

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

View all 44

NPI Registry JSON

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

{
    "created_epoch": "1202169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651190400000",
    "number": "1356529028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 MOUNTAIN VIEW AVE",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805013128",
            "telephone_number": "720-718-8305",
            "fax_number": "303-485-3377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 MOUNTAIN VIEW AVE",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805013128",
            "telephone_number": "720-718-8305",
            "fax_number": "303-485-3377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISHER",
        "first_name": "MARK",
        "middle_name": "BRADLEY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-05",
        "last_updated": "2022-04-29",
        "certification_date": "2022-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IL",
            "license": "036122470",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CO",
            "license": "054743",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036122470",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER COMMERCIAL NUMBER",
            "identifier": "025542",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "61402516",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "CAREQUALITY",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "280 Exempla Cir",
            "city": "Lafayette",
            "state": "CO",
            "country_code": "US",
            "postal_code": "800263370",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Longmont, CO

Sources for this page

Verify at the official NPI Registry.