Individual provider Active NPI

Mark James Lisowski, M.D.

  • Emergency Medicine Physician
  • Mount Vernon, WA
National Provider Identifier
1477917797
Registry record updated Aug 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD60920069 Issued in WA
Practice address
1415 E Kincaid St
Mount Vernon, WA 98274-4126
Phone
(360) 424-4111
NPI assigned
Apr 12, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 6, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X R75483 AZ
Emergency Medicine Physician 207P00000X MD60920069 WA Primary

Addresses

Primary practice location

1415 E Kincaid St
Mount Vernon, WA 98274-4126

Mailing address

1415 E Kincaid St
Mount Vernon, WA 98274-4126
Phone (360) 424-4111

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190822000946 WA Practitioner - Emergency Medicine 1658626759 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Washington School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northwest Emergency Physicians LLCGroup PAC ID 3476462334, 267 clinicians

Practice addresses (Care Compare)

330 S Stillaguamish Ave
Arlington, WA 98223-1642
Phone (360) 435-2133

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD60920069WAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Benson Hospital Corporation CurrentSince Sep 1, 2018 Accepting new patients
Northwest Emergency Physicians LLC Emergency Medicine CurrentSince Oct 1, 2019 Accepting new patients
Benson Hospital Corporation CurrentSince Sep 1, 2018 Accepting new patients

Locations

450 S Ocotillo St
Benson, AZ 85602
Phone (520) 586-2261

1211 24th St
Anacortes, WA 98221
Phone (360) 293-3181

330 S Stillaguamish Ave
Arlington, WA 98223
Phone (360) 435-2133

1415 E Kincaid St
Mount Vernon, WA 98274
Phone (360) 416-5750

888 Swift Blvd
Richland, WA 99352
Phone (509) 942-2115

1717 S J St
Tacoma, WA 98405
Phone (253) 426-4101

Interoperability endpoints

  • Direct secure messaging: mlisowski30211@skagit.direct-ci.com

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1460419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722902400000",
    "number": "1477917797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 E KINCAID ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744126",
            "telephone_number": "360-424-4111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 E KINCAID ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744126",
            "telephone_number": "360-424-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISOWSKI",
        "first_name": "MARK",
        "middle_name": "JAMES",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-04-12",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AZ",
            "license": "R75483",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": "MD60920069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, WA

Sources for this page

Verify at the official NPI Registry.