Mark David Perez, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

9700706 Issued in NC

Practice address

3601 W Commercial Blvd Ste 20
Fort Lauderdale, FL 33309-3334

Phone

(954) 368-4560

Fax

(954) 530-6418

NPI assigned

Jun 14, 2005

Last updated

May 26, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 6

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

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.

• Jefferson Emergency Services, PLLC

  • Emergency Medicine Physician
  • Jefferson, NC
  • NPI 1720495336
  Medicare reassignment NPD
• J. Arthur Dosher Memorial Hospital

  • General Acute Care Hospital
  • Southport, NC
  • NPI 1275660342
  NPD
• Pender Memorial Hospital, Incorporated

  dba Novant Health Pender Medical Center

  • Critical Access Hospital
  • Burgaw, NC
  • NPI 1295703130
  NPD (past)

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

{
    "created_epoch": "1118707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621987200000",
    "number": "1396740783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 936857",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311936857",
            "telephone_number": "910-662-6600",
            "fax_number": "910-332-0246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 W COMMERCIAL BLVD STE 20",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333093334",
            "telephone_number": "954-368-4560",
            "fax_number": "954-530-6418"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1333 S Dickinson Dr Unit 140",
            "address_purpose": "LOCATION",
            "city": "Leland",
            "state": "NC",
            "postal_code": "284516434",
            "country_code": "US",
            "telephone_number": "910-662-6600",
            "fax_number": "910-332-0246",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "MARK",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-14",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME130601",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "9700706",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891306J",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "C3864",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1306J",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080192422",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "39-01069",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080185873",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mperez6812@direct.nhrmc.org",
            "affiliation": "N",
            "address_1": "1333 S Dickinson Dr Unit 140",
            "city": "Leland",
            "state": "NC",
            "country_code": "US",
            "postal_code": "284516434",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Elys Maria Perez, MD
• Gregory L Perez, MD
• Jennifer Perez, LCSW
• Jorge Alexander Perez, M.D.
• Luis A Perez
• Michael A. Perez, M.D.
• Olivia Perez, RBT
• Patricia Perez, DMD
• Styl Perez, DDS
• Tracy Perez, PSY.D.

• Family Medicine Physician in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2021; 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.