NPIMap

Individual provider Active NPI

Mark L. Davis, P.A.-C

  • Medical Physician Assistant
  • Shawnee, OK
National Provider Identifier
1487747713
Registry record updated Aug 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA801 Issued in OK
Practice address
3315 Kethley Rd
Shawnee, OK 74804-9638
Phone
(405) 273-5801
Fax
(405) 878-3814
NPI assigned
Sep 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA801 OK Primary

Addresses

Primary practice location

3315 Kethley Rd
Shawnee, OK 74804-9638

Mailing address

PO Box 849
Shawnee, OK 74802-0849
Phone (405) 273-5801

Other identifiers 1

IdentifierTypeStateIssuer
100715900BMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081008000850 OK Practitioner - Physician Assistant 9739257387 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Saints Medical Group, LLCGroup PAC ID 7012914898, 430 clinicians

Practice addresses (Care Compare)

1102 W Macarthur St
Shawnee, OK 74804-1743
Phone (405) 273-2270

3315 Kethley Rd
Shawnee, OK 74804-9638
Phone (405) 273-5801

608 NW 9TH St
Oklahoma City, OK 73102-1049

Hospital & facility affiliations

  • Loving Care in-Home Health Services, L.L.C. Home health agency, Noble, OK, CCN 377604
  • Cohesive Healthcare Home health agency, Shawnee, OK, CCN 377781
  • SSM Health at Home Home Health - Oklahoma Home health agency, Oklahoma City, OK, CCN 377035
  • SSM Health St Anthony Hospital - Shawnee Hospital, Shawnee, OK, CCN 370149
  • Mercy Hospital Ada Hospital, Ada, OK, CCN 370020
  • SSM Health St Anthony Hospital - Oklahoma City Hospital, Oklahoma City, OK, CCN 370037
  • O U Medical Center Hospital, Oklahoma City, OK, CCN 370093
  • Oklahoma Heart Hospital, LLC Hospital, Oklahoma City, OK, CCN 370215

Merit-based Incentive Payment System (MIPS)

Final score
84.48 of 100Reported as group
Quality
81.18
Promoting interoperability
93
Improvement activities
40
Cost
72.93

Merit-based Incentive Payment System (MIPS)

Final score
85.96 of 100Reported as group
Quality
80.43
Promoting interoperability
100
Improvement activities
40
Cost
72.76

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
801OKMDPsychologist
PA801OKMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Saints Medical Group, LLC CurrentSince Apr 1, 2024 Accepting new patients
Saints Medical Group, LLC CurrentSince Apr 1, 2024 Accepting new patients
St Anthony Shawnee Hospital Inc Past Accepting new patients
Summit Medical Center Past Accepting new patients
St Anthony Shawnee Hospital Inc Past Accepting new patients

Locations

608 NW 9th St
Ste 2200
Oklahoma City, OK 73102
Phone (405) 231-3737

608 NW 9th St
Ste 1100
Oklahoma City, OK 73102
Phone (405) 231-3000

1102 W MacArthur St
Shawnee, OK 74804
Phone (405) 273-2270

3700 N Kickapoo Ave
Ste 124
Shawnee, OK 74804
Phone (405) 273-6383

3315 Kethley Rd
Shawnee, OK 74804
Phone (405) 273-5801

Interoperability endpoints

  • Direct secure messaging: mdavis164642@direct-ehr-ssmhc.com

Organizations & group practices 5

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 9

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": "1159574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346198400000",
    "number": "1487747713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 849",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748020849",
            "telephone_number": "405-273-5801",
            "fax_number": "495-878-3814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3315 KETHLEY RD",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748049638",
            "telephone_number": "405-273-5801",
            "fax_number": "405-878-3814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "MARK",
        "middle_name": "L.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-30",
        "last_updated": "2012-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "PA801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100715900B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shawnee, OK

Sources for this page

Verify at the official NPI Registry.