NPIMap

Individual provider Active NPI

Mark W Davis, M.D.

  • Specialist
  • Norfolk, NE
National Provider Identifier
1376626416
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
17496 Issued in NE
Practice address
109 North 29TH Street-Suite 1
Norfolk, NE 68701
Phone
(402) 644-4600
Fax
(402) 644-3430
NPI assigned
Oct 23, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 17496 NE Primary

Addresses

Primary practice location

109 North 29TH Street-Suite 1
Norfolk, NE 68701

Mailing address

109 North 29TH Street-Suite 1
Norfolk, NE 68701
Phone (402) 644-4600

Other identifiers 1

IdentifierTypeStateIssuer
10025059200MedicaidNE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080630000067 NE Practitioner - Obstetrics/Gynecology 3072685544 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
80.77 of 100Reported as group
Quality
67.03
Promoting interoperability
96
Improvement activities
40
Cost
72.22

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
17496NEMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Faith Regional Health Services PastSince Sep 1, 2015 Accepting new patients

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Faith HealthNorfolk, NE, CCN 280125 Hospital W-2 Managing Employee
Operational/Managerial Control		 May 27, 2019
May 27, 2019
Faith HealthNorfolk, NE, CCN 28T125 Hospital W-2 Managing Employee
Operational/Managerial Control		 May 27, 2019
May 27, 2019
Faith Regional Health Services Home HealthNorfolk, NE, CCN 287089 Home health agency W-2 Managing Employee
Operational/Managerial Control		 May 27, 2019
May 27, 2019
Faith Health HospiceNorfolk, NE, CCN 281509 Hospice W-2 Managing Employee
Operational/Managerial Control		 May 27, 2019
May 27, 2019

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376626416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 NORTH 29TH STREET-SUITE 1",
            "city": "NORFOLK",
            "state": "NE",
            "postal_code": "68701",
            "telephone_number": "402-644-4600",
            "fax_number": "402-644-3430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 NORTH 29TH STREET-SUITE 1",
            "city": "NORFOLK",
            "state": "NE",
            "postal_code": "68701",
            "telephone_number": "402-644-4600",
            "fax_number": "402-644-3430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "MARK",
        "middle_name": "W",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NE",
            "license": "17496",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025059200",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norfolk, NE

Sources for this page

Verify at the official NPI Registry.