Mark D Coram, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA60118218 Issued in WA

Practice address

401 W Poplar St
Psmpg Sleep Medicine
Walla Walla, WA 99362-2846

Phone

(509) 522-5845

Fax

(509) 522-5527

NPI assigned

Nov 19, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Providence Health and Services - WashingtonGroup PAC ID 2860552973, 266 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence St Mary Medical Center Hospital, Walla Walla, WA, CCN 500002

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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 and National Provider Directory roles.

• Providence Health & Services - Washington

  • Family Medicine Physician
  • Walla Walla, WA
  • NPI 1922259738
  Medicare reassignment Care Compare group NPD
• Providence Health & Services - Washington

  • Emergency Medicine Physician
  • Walla Walla, WA
  • NPI 1699926402
  NPD
• Providence Health & Services - Washington

  • General Acute Care Hospital
  • Walla Walla, WA
  • NPI 1386895886
  NPD (past)

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

• Providence Health & Services - Washington

  • General Acute Care Hospital
  • Walla Walla, WA
  • NPI 1386895886
  Care Compare affiliation

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

{
    "created_epoch": "1258588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620604800000",
    "number": "1407184021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34439",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981241439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 W POPLAR ST",
            "address_2": "PSMPG SLEEP MEDICINE",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993622846",
            "telephone_number": "509-522-5845",
            "fax_number": "509-522-5527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORAM",
        "first_name": "MARK",
        "middle_name": "D",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-11-19",
        "last_updated": "2021-05-10",
        "certification_date": "2021-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60118218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407184021",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500629795",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mcoram186175@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "401 W Poplar St",
            "address_2": "PSMPG Sleep Medicine",
            "city": "Walla Walla",
            "state": "WA",
            "country_code": "US",
            "postal_code": "993622846",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Delores A Conrad, LICSW
• Julie Ann Cooke, CF-SLP
• Patricia S. Cooper, PHD
• Cheryl Copeland, RN
• Kelsey Marie Copenhaver
• Moises Cordova, PA-C
• Ryan Todd Cornia, DPM
• Itsel Corona Madrigal
• Elizabeth Corrales
• Jeffery Michael Cortez, PHARMD, MBA

• Physician Assistant in Walla Walla, WA
• Providers in Walla Walla, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.