NPIMap

Individual provider Active NPI

Mark David Ewalt, M.D.

  • Molecular Genetic Pathology (Pathology) Physician
  • New York, NY
National Provider Identifier
1497998512
Registry record updated Aug 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Molecular Genetic Pathology (Pathology) PhysicianTaxonomy code 207ZP0007X
License
DR.0058760 Issued in CO
Practice address
1275 York Avenue
Dept of Pathology, Box #36
New York, NY 10065
Phone
(212) 639-8137
NPI assigned
Apr 20, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Cytopathology Physician 207ZC0500X DR.0058760 CO
Hematology (Pathology) Physician 207ZH0000X A121762 CA
Hematology (Pathology) Physician 207ZH0000X DR.0058760 CO
Molecular Genetic Pathology (Pathology) Physician 207ZP0007X DR.0058760 CO Primary

Addresses

Primary practice location

1275 York Avenue
Dept of Pathology, Box #36
New York, NY 10065

Mailing address

1275 York Avenue
Dept of Pathology, Box #36
New York, NY 10065
Phone (212) 639-8137

Other practice location 1

12605 E 16th Ave
Aurora, CO 80045-2545
Phone (720) 848-0000

Other practice location 2

8700 Beverly Blvd
SPT Room 4703
West Hollywood, CA 90048-1804
Phone (310) 423-4551

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150818005040 CA Practitioner - Pathology 4183939226 Reassigns benefits to 1 organization
I20201023001759 NY Practitioner - Pathology 4183939226 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Columbia University College of Physicians and Surgeons, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Pathology GroupGroup PAC ID 0749179158, 98 clinicians

Practice addresses (Care Compare)

1275 York Ave
New York, NY 10065-6007
Phone (212) 639-2000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
76.67 of 100Reported as group
Quality
70
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
121762CAMDMarriage & Family Therapist
A121762CAMDHematology (Pathology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Pathology Group CurrentSince Jul 1, 2020 Accepting new patients
Cedars-Sinai Medical Care Foundation CurrentSince Jul 1, 2015 Accepting new patients

Locations

8635 W 3rd St
Ste 465W
Los Angeles, CA 90048
Phone (310) 423-0674

4140 W 190th St
Torrance, CA 90504
Phone (310) 967-1780

8700 Beverly Blvd
West Hollywood, CA 90048
Phone (310) 385-3291

8700 Beverly Blvd
Rm 4703
West Hollywood, CA 90048
Phone (310) 423-4551

1275 York Ave
New York, NY 10065
Phone (212) 639-3813

1275 York Ave
#36
New York, NY 10065
Phone (212) 639-7102

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1240185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629849600000",
    "number": "1497998512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 YORK AVENUE",
            "address_2": "DEPT OF PATHOLOGY, BOX #36",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10065",
            "telephone_number": "212-639-8137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 YORK AVENUE",
            "address_2": "DEPT OF PATHOLOGY, BOX #36",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10065",
            "telephone_number": "212-639-8137"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12605 E 16th Ave",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "CO",
            "postal_code": "800452545",
            "country_code": "US",
            "telephone_number": "720-848-0000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8700 Beverly Blvd",
            "address_2": "SPT Room 4703",
            "address_purpose": "LOCATION",
            "city": "West Hollywood",
            "state": "CA",
            "postal_code": "900481804",
            "country_code": "US",
            "telephone_number": "310-423-4551",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EWALT",
        "first_name": "MARK",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-20",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZC0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Cytopathology",
            "state": "CO",
            "license": "DR.0058760",
            "primary": false
        },
        {
            "code": "207ZH0000X",
            "taxonomy_group": "",
            "desc": "Pathology, Hematology",
            "state": "CA",
            "license": "A121762",
            "primary": false
        },
        {
            "code": "207ZH0000X",
            "taxonomy_group": "",
            "desc": "Pathology, Hematology",
            "state": "CO",
            "license": "DR.0058760",
            "primary": false
        },
        {
            "code": "207ZP0007X",
            "taxonomy_group": "",
            "desc": "Pathology, Molecular Genetic Pathology",
            "state": "CO",
            "license": "DR.0058760",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.