Active NPI
Mark D Gibson, MD
- Orthopaedic Surgery Physician
- Elmira, NY
National Provider Identifier
1396757753
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- 145863
- Practice address
- 300 Hoffman St
Elmira, NY 14905-2263 - Phone
- (607) 734-4110
- Fax
- (607) 734-0344
- NPI assigned
- Aug 13, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 145863 | NY | Primary |
Addresses
Primary practice location
300 Hoffman St
Elmira, NY 14905-2263
Mailing address
571 Saint Josephs Blvd FL 2
Elmira, NY 14901-3230
Phone (607) 271-2050
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 102406367 | Medicaid | PA | |
| 00627225 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 145863 | NY | MD | Orthopaedic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Finger Lakes Orthopedic Surgery,P.C. | Past | Accepting new patients | |
| Fort Edward Rescue Squad Inc | Past | Accepting new patients | |
| Chemung Medical Services PC | Orthopaedic Surgery | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Legal Medicine
- Elmira, NY
- NPI 1699712505
-
- Internal Medicine Physician
- Elmira, NY
- NPI 1356378889
Orthopaedic Surgery
-
- Ambulance
- Fort Edward, NY
- NPI 1427031319
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465516800000",
"number": "1396757753",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "571 SAINT JOSEPHS BLVD FL 2",
"city": "ELMIRA",
"state": "NY",
"postal_code": "149013230",
"telephone_number": "607-271-2050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 HOFFMAN ST",
"city": "ELMIRA",
"state": "NY",
"postal_code": "149052263",
"telephone_number": "607-734-4110",
"fax_number": "607-734-0344"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "MARK",
"middle_name": "D",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-13",
"last_updated": "2016-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "NY",
"license": "145863",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "102406367",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00627225",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Elmira, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.