Mark W McDonald, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

BP10041308 Issued in TX

Practice address

629 Winding Brook LN
Tyler, TX 75703-0832

Phone

(903) 352-4840

Fax

(903) 352-4840

NPI assigned

May 31, 2011

Last updated

Jan 9, 2017By 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 1

Medicare fee-for-service enrollment

Enrolled in TX

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

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.

• Texas Spine and Joint Hospital, LLC

  dba Baylor Scott & White TX Spine & Joint Hos Imaging Ctr

  • General Acute Care Hospital
  • Tyler, TX
  • NPI 1942292255
  Medicare reassignment NPD
• Complete Emergency Care Tyler LLC

  • Emergency Care Clinic/Center
  • Tyler, TX
  • NPI 1124486857
  NPD (past)

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

{
    "created_epoch": "1306800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483920000000",
    "number": "1407140106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "629 WINDING BROOK LN",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757030832",
            "telephone_number": "903-352-4840",
            "fax_number": "903-352-4840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "629 WINDING BROOK LN",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757030832",
            "telephone_number": "903-352-4840",
            "fax_number": "903-352-4840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDONALD",
        "first_name": "MARK",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-31",
        "last_updated": "2017-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "LA",
            "license": "206929",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "BP10041308",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2367145",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Arlene Kay McDonald, LPC
• Breayah McDonald
• Hanna Rose McDonald, DO
• Jackie Lynn McDonald, RN, COHN-S, CAOHC
• Joanne Marie McDonald, DNAP, CRNA
• Michele Dawn McDonald, AGACNP-BC
• Shelby McDonald
• Spencer McDonald
• Kebra Renee McDougal, PHARMD
• Marci McDougald

• Family Medicine Physician in Tyler, TX
• Providers in Tyler, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2017; 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.