Mark Farabee Craddock, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD00020137 Issued in WA

Practice address

4700 Point Fosdick Dr
Gig Harbor, WA 98335-1706

Phone

(253) 851-5121

Fax

(253) 851-3059

NPI assigned

Feb 8, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Peninsula Family Medical Center

  • Family Medicine Physician
  • Gig Harbor, WA
  • NPI 1588674998
  Medicare reassignment NPD

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621382400000",
    "number": "1497728901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 POINT FOSDICK DR STE 220",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983351706",
            "telephone_number": "253-851-5121",
            "fax_number": "253-851-3059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 POINT FOSDICK DR",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983351706",
            "telephone_number": "253-851-5121",
            "fax_number": "253-851-3059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRADDOCK",
        "first_name": "MARK",
        "middle_name": "FARABEE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-08",
        "last_updated": "2021-05-19",
        "certification_date": "2021-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00020137",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8344509",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tori Mae Couture
• Ken A Cox, RPH
• Jodi Coy, LICSW
• Richard Mason Coyner, DDS
• Crackyourbackjack, Inc.
• Jonathan William Ralph Crane
• Crescent Psychiatry
• Rachel L Criddle, DNP, FNP
• Sarah K Crockett, DC
• Claudia K Crowe, MA, OTR/L

• Family Medicine Physician in Gig Harbor, WA
• Providers in Gig Harbor, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.