Mark E Hinkson Dermatology PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

O-323 Issued in ID

Legal business name

MARK E HINKSON DERMATOLOGY PA

Practice address

3425 Merlin Dr Ste 200
Idaho Falls, ID 83404-7430

Phone

(208) 528-6653

Fax

(208) 528-6676

NPI assigned

Dec 12, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Mark Eldon Hinkson, D.ONPI 1538257431

Title

President

Phone

(208) 528-6653

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Mountain West Dermatology Doing business as

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark E Hinkson, D.O.

  • Dermatology Physician
  • Idaho Falls, ID
  • NPI 1538257431
  Medicare reassignment Care Compare group NPD Authorized official
• Tai Banta

  • Physician Assistant
  • Idaho Falls, ID
  • NPI 1467185843
  Medicare reassignment Care Compare group
• Krystal Ray, PA-C

  • Physician Assistant
  • Idaho Falls, ID
  • NPI 1750011011
  Medicare reassignment Care Compare group
• Robert Willis, PA-C

  • Medical Physician Assistant
  • Idaho Falls, ID
  • NPI 1235331802
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1437210994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3425 MERLIN DR STE 200",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047430",
            "telephone_number": "208-528-6653",
            "fax_number": "208-528-6676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3425 MERLIN DR STE 200",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047430",
            "telephone_number": "208-528-6653",
            "fax_number": "208-528-6676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK E HINKSON DERMATOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HINKSON",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ELDON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-528-6653",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "ID",
            "license": "O-323",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMBA",
            "identifier": "863436",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELS",
            "identifier": "10147364",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "S4927",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain West Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mark a Weight MD PC
• Mark a. Tall, P.a.
• Mark Bennett PLLC
• Mark E Freeman M.D. PC
• Mark E Freeman MD PC
• Leslie Markiel, LMT
• Jessica Marley, LMSW
• Ann Marlowe
• Phillip Marlowe, PA-C
• Amanda Marotz Roemer, LCPC

• Dermatology Physician in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Dermatology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.