Individual provider Active NPI

Mark Fender, M.D.

  • Anesthesiology Physician
  • Sault Sainte Marie, MI
National Provider Identifier
1447205539
Registry record updated Jan 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
4301065200 Issued in MI
Practice address
500 Osborn Blvd
Sault Sainte Marie, MI 49783-1822
Phone
(906) 635-4390
NPI assigned
May 24, 2006
Last updated
Jan 24, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 4301065200 MI
Anesthesiology Physician 207L00000X 4301065200 MI Primary

Addresses

Primary practice location

500 Osborn Blvd
Sault Sainte Marie, MI 49783-1822

Mailing address

744 W Michigan Ave
Jackson, MI 49201-1909
Phone (517) 787-6440

Other practice location 1

419 S Coral St
Kalkaska, MI 49646-2503
Phone (231) 258-7777

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110203000394 MI Practitioner - Anesthesiology 5395703003 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301065200MIMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kalkaska Memorial Health Center CurrentSince Jan 24, 2024 Accepting new patients
Kalkaska Memorial Health Center CurrentSince Jan 24, 2024 Accepting new patients
Munson Medical Group CurrentSince Mar 31, 2024 Accepting new patients
Munson Medical Group CurrentSince Mar 31, 2024 Accepting new patients
Munson Medical Center Anesthesiology CurrentSince Feb 1, 2025 Accepting new patients
Munson Medical Group Current Accepting new patients
Munson Medical Center CurrentSince Feb 1, 2025 Accepting new patients
Macatawa Anesthesia PC Anesthesiology CurrentSince Nov 1, 2003 Accepting new patients

Locations

602 Michigan Ave
Holland, MI 49423
Phone (616) 394-3350

419 S Coral St
Kalkaska, MI 49646
Phone (231) 258-7500

1105 Sixth St
Ste 103
Traverse City, MI 49684
Phone (231) 935-6455

1200 Sixth St
Ste 200
Traverse City, MI 49684

4100 Park Forest Dr
Traverse City, MI 49684
Phone (231) 392-8900

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706054400000",
    "number": "1447205539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "744 W MICHIGAN AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011909",
            "telephone_number": "517-787-6440",
            "fax_number": "517-787-4146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 OSBORN BLVD",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497831822",
            "telephone_number": "906-635-4390"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "419 S Coral St",
            "address_purpose": "LOCATION",
            "city": "Kalkaska",
            "state": "MI",
            "postal_code": "496462503",
            "country_code": "US",
            "telephone_number": "231-258-7777",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FENDER",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-24",
        "last_updated": "2024-01-24",
        "certification_date": "2024-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MI",
            "license": "4301065200",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MI",
            "license": "4301065200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sault Sainte Marie, MI

Sources for this page

Verify at the official NPI Registry.