Individual provider Active NPI

Mark Calvin Robertson, M.D.

  • Anesthesiology Physician
  • San Antonio, TX
National Provider Identifier
1417930025
Registry record updated Jul 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
J0225 Issued in TX
Practice address
3510 N Loop 1604 E
San Antonio, TX 78247-2303
Phone
(210) 375-7790
Fax
(210) 979-9686
NPI assigned
Nov 29, 2005
Last updated
Jul 29, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X J0225 TX Primary

Addresses

Primary practice location

3510 N Loop 1604 E
San Antonio, TX 78247-2303

Mailing address

PO Box 840853
Dallas, TX 75284-0853
Phone (210) 375-7790

Other identifiers 1

IdentifierTypeStateIssuer
1061590-02MedicaidTX

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20100825000547 TX Practitioner - Anesthesiology 4284758426 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Texas Tech University Health Science Center School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
U S Anesthesia Partners of Texas, PAGroup PAC ID 7315850351, 2,750 clinicians

Practice addresses (Care Compare)

100 Medical Dr
Lake Jackson, TX 77566-5674
Phone (713) 496-7555

1139 E Sonterra Blvd
San Antonio, TX 78258-4347
Phone (210) 638-2100

12412 Judson Rd
Live Oak, TX 78233-3255
Phone (210) 757-7000

15900 La Cantera Pkwy
Suite 20210
San Antonio, TX 78256-2464
Phone (210) 607-4687

520 Madison Oak Dr
San Antonio, TX 78258-3913
Phone (210) 297-4000

7930 Floyd Curl Dr
San Antonio, TX 78229-3925
Phone (210) 297-5000

8811 Village Dr
San Antonio, TX 78217-5415
Phone (210) 297-2000

9250 Pinecroft Dr
Shenandoah, TX 77380-3218
Phone (713) 620-4000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.94 of 100Reported as group
Quality
91.31
Improvement activities
40
Cost
79.05

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
J0225TXMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
U S Anesthesia Partners of Texas, PA Anesthesiology CurrentSince Sep 3, 2019 Accepting new patients
U. S. Anesthesia Partners of Texas, P.a., Anesthesiology CurrentSince Sep 3, 2019 Accepting new patients

Locations

100 Medical Dr
Lake Jackson, TX 77566
Phone (713) 496-7555

9250 Pinecroft Dr
Shenandoah, TX 77380
Phone (281) 364-2300

Organizations & group practices 2

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1133222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595980800000",
    "number": "1417930025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 840853",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752840853",
            "telephone_number": "210-375-7790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3510 N LOOP 1604 E",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782472303",
            "telephone_number": "210-375-7790",
            "fax_number": "210-979-9686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "MARK",
        "middle_name": "CALVIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-29",
        "last_updated": "2020-07-29",
        "certification_date": "2020-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "TX",
            "license": "J0225",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1061590-02",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.