NPIMap

Individual provider Active NPI

Mark J Logan, PA-C

  • Physician Assistant
  • Anchorage, AK
National Provider Identifier
1508994104
Registry record updated Jun 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
965 Issued in AK
Practice address
3841 Piper St
Suite T300
Anchorage, AK 99508-4624
Phone
(907) 563-3103
Fax
(907) 561-1862
NPI assigned
Mar 2, 2007
Last updated
Jun 21, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA05197 TX
Physician Assistant 363A00000X 965 AK Primary

Addresses

Primary practice location

3841 Piper St
Suite T300
Anchorage, AK 99508-4624

Mailing address

3841 Piper St
Suite T300
Anchorage, AK 99508-4624
Phone (907) 563-3103

Other identifiers 2

IdentifierTypeStateIssuer
1039349MedicaidLA
MDA0383MedicaidAK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA, MS2 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
I20090421000059 LA Practitioner - Physician Assistant 5991805442 Reassigns benefits to 1 organization
I20231212000570 MS Practitioner - Physician Assistant 5991805442 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Hospital at GulfportGroup PAC ID 2466524012, 473 clinicians
Ochsner Clinic LLCGroup PAC ID 8224933619, 2,845 clinicians

Practice addresses (Care Compare)

1340 Broad Ave
Gulfport, MS 39501-2460

1340 Broad Ave
Gulfport, MS 39501-2465

4300 Leisure Time Dr
Diamondhead, MS 39525-3241
Phone (228) 255-4300

8050 W Judge Perez Dr
Ochsner Health Center St Bernard
Chalmette, LA 70043-1734
Phone (504) 304-2800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
965AKMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital at Gulfport CurrentSince Dec 4, 2023 Accepting new patients
Memorial Hospital at Gulfport CurrentSince Dec 4, 2023 Accepting new patients
Foucher Emergency Physicians Physician Assistant Past Accepting new patients
Memorial Hospital at Gulfport Past Accepting new patients
Louisiana Em-1 Medical Services, PA Physician Assistant Past Accepting new patients

Locations

4300 Leisure Time Dr
Diamondhead, MS 39525
Phone (228) 255-4300

1340 Broad Ave
Ste 440
Gulfport, MS 39501
Phone (228) 867-4856

Interoperability endpoints

  • Direct secure messaging: mlogan@direct.mhg.com

Organizations & group practices 7

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 62

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

View all 62

NPI Registry JSON

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

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308614400000",
    "number": "1508994104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3841 PIPER ST",
            "address_2": "SUITE T300",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995084624",
            "telephone_number": "907-563-3103",
            "fax_number": "907-561-1862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3841 PIPER ST",
            "address_2": "SUITE T300",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995084624",
            "telephone_number": "907-563-3103",
            "fax_number": "907-561-1862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGAN",
        "first_name": "MARK",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-02",
        "last_updated": "2011-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA05197",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AK",
            "license": "965",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1039349",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MDA0383",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anchorage, AK

Sources for this page

Verify at the official NPI Registry.