Individual provider Active NPI

Mark Evan Gerber, MD

  • Pediatric Otolaryngology Physician
  • Phoenix, AZ
National Provider Identifier
1487765319
Registry record updated Aug 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Otolaryngology PhysicianTaxonomy code 207YP0228X
License
58195 Issued in AZ
Practice address
1920 E Cambridge Ave Ste 201
Phoenix, AZ 85006-1462
Phone
(602) 933-3277
Fax
(602) 933-4326
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 036100171 IL
Pediatric Otolaryngology Physician 207YP0228X 58195 AZ Primary

Addresses

Primary practice location

1920 E Cambridge Ave Ste 201
Phoenix, AZ 85006-1462

Mailing address

3200 E Camelback Rd Ste 250
Phoenix, AZ 85018-2327
Phone (602) 933-1813

Other identifiers 1

IdentifierTypeStateIssuer
499847MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, AZ2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20050909000167 IL Practitioner - Otolaryngology 2567494628 Reassigns benefits to 1 organization
I20190517001168 AZ Practitioner - Otolaryngology 2567494628 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Loyola University of Chicago, Stritch School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Phoenix Children'S HospitalGroup PAC ID 0446278584, 431 clinicians

Practice addresses (Care Compare)

1919 E Thomas Rd
Phoenix, AZ 85016-7710
Phone (602) 933-0930

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036100171ILMDOtolaryngology Physician
58195AZMDPediatric Otolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group Otolaryngology CurrentSince Apr 26, 2011 Accepting new patients
Phoenix Children'S Medical Group CurrentSince Jun 1, 2019 Accepting new patients
Phoenix Children'S Hospital Current Accepting new patients
Endeavor Health Medical Group CurrentSince Apr 26, 2011 Accepting new patients
Phoenix Children'S Medical Group CurrentSince Jun 1, 2019 Accepting new patients

Locations

6524 W Sack Dr
Ste 130
Glendale, AZ 85308

1919 E Thomas Rd
Phoenix, AZ 85016
Phone (602) 933-0777

1920 E Cambridge Ave
Ste 201
Phoenix, AZ 85006
Phone (602) 254-5561

1920 E Cambridge Ave
Ste 200
Phoenix, AZ 85006
Phone (602) 933-0965

3200 E Camelback Rd
Ste 250
Phoenix, AZ 85018
Phone (602) 933-1814

9532 Eagle Way
Chicago, IL 60678

49 S Waukegan Rd
Ste 200
Deerfield, IL 60015
Phone (847) 945-4575

1000 Central St
Ste 610
Evanston, IL 60201
Phone (847) 570-1015

2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

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.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566518400000",
    "number": "1487765319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 E CAMELBACK RD STE 250",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850182327",
            "telephone_number": "602-933-1813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 E CAMBRIDGE AVE STE 201",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850061462",
            "telephone_number": "602-933-3277",
            "fax_number": "602-933-4326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GERBER",
        "first_name": "MARK",
        "middle_name": "EVAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2019-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IL",
            "license": "036100171",
            "primary": false
        },
        {
            "code": "207YP0228X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Pediatric Otolaryngology",
            "state": "AZ",
            "license": "58195",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "499847",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.