Active NPI
Mark Nelson
- Perfusionist
- Kettering, OH
National Provider Identifier
1457590994
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Perfusionist
- License
- 839075
- Practice address
- 3533 Southern Blvd
Ste 5650
Kettering, OH 45429-1264 - Phone
- (937) 294-3611
- Fax
- (937) 294-9010
- NPI assigned
- Feb 6, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Perfusionist | 242T00000X | 839075 | OH | Primary |
Addresses
Primary practice location
3533 Southern Blvd
Ste 5650
Kettering, OH 45429-1264
Mailing address
3533 Southern Blvd
Ste 5650
Kettering, OH 45429-1264
Phone (937) 294-3611
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 839075 | OH | MD | Perfusionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1233878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233878400000",
"number": "1457590994",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3533 SOUTHERN BLVD",
"address_2": "STE 5650",
"city": "KETTERING",
"state": "OH",
"postal_code": "454291264",
"telephone_number": "937-294-3611",
"fax_number": "937-294-9010"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3533 SOUTHERN BLVD",
"address_2": "STE 5650",
"city": "KETTERING",
"state": "OH",
"postal_code": "454291264",
"telephone_number": "937-294-3611",
"fax_number": "937-294-9010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "MARK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-02-06",
"last_updated": "2009-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "242T00000X",
"taxonomy_group": "",
"desc": "Perfusionist",
"state": "OH",
"license": "839075",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kettering, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.