NPIMap

Individual provider Active NPI

Mark Douglas Fish, D.O.

  • Orthopaedic Surgery Physician
  • Clive, IA
National Provider Identifier
1548212368
Registry record updated Jan 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
3790 Issued in IA
Practice address
12499 University Ave
Ste. 210
Clive, IA 50325-8288
Phone
(515) 440-2676
Fax
(515) 440-2677
NPI assigned
May 17, 2006
Last updated
Jan 23, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2013

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 3790 IA Primary
Orthopaedic Surgery Physician 207X00000X 02003044A IN
Adult Reconstructive Orthopaedic Surgery Physician 207XS0114X 02003044A IN
Orthopaedic Foot and Ankle Surgery Physician 207XX0004X 02003044A IN
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 02003044A IN

Addresses

Primary practice location

12499 University Ave
Ste. 210
Clive, IA 50325-8288

Mailing address

12499 University Ave
Ste. 210
Clive, IA 50325-8288
Phone (515) 440-2676

Other identifiers 6

IdentifierTypeStateIssuer
000000480577OtherINBCBS
4178250001OtherINDME
7305819OtherINAETNA
2655165OtherINUNITED HEALTH CARE
075965OtherINSIHO
P00325521OtherINRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20070509000079 IA Practitioner - Orthopedic Surgery 1951312305 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Knoxville Community Hospital IncGroup PAC ID 6608787056, shared by 3 NPIs, 34 clinicians
Capital Orthopaedics and Sports Medicine PCGroup PAC ID 3476691551, 19 clinicians
Broadlawns Medical CenterGroup PAC ID 3678466166, 302 clinicians

Practice addresses (Care Compare)

1202 W Howard St
Knoxville, IA 50138-3103
Phone (641) 828-7211

12499 University Ave
Suite 210
Clive, IA 50325-8288
Phone (515) 440-2676

1801 Hickman Rd
Des Moines, IA 50314-1548
Phone (515) 282-2200

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement27
Knee replacement40
Lower limb (leg) arthroscopy (minimally invasive joint repair)15
Upper limb (arm) arthroscopy (minimally invasive joint repair)52

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
3790IAMDOrthopaedic Surgery Physician
02003044AINMDSports Medicine (Orthopaedic Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Broadlawns Medical Center CurrentSince Jul 28, 2024 Accepting new patients
St Luke's Methodist Hospital Current Accepting new patients
Boone County Comprehensive Specialty Care Orthopaedic Surgery CurrentSince May 20, 2024 Accepting new patients
Boone County Hospital Current Accepting new patients
Broadlawns Medical Center CurrentSince Jul 28, 2024 Accepting new patients
Knoxville Community Hospital Inc CurrentSince Jul 1, 2017 Accepting new patients
Knoxville Community Hospital Inc Current Accepting new patients
Knoxville Community Hospital Inc Current Accepting new patients
Capital Orthopaedics and Sports Medicine PC Orthopaedic Surgery CurrentSince Jan 1, 2010 Accepting new patients
Joint Replacement Surgeons of Indiana Orthopaedic Surgery Past Accepting new patients
Capital Orthopaedics and Sports Medicine LLP Orthopaedic Surgery Past Accepting new patients
Boone County Hospital Past Accepting new patients

Locations

1015 Union St
Boone, IA 50036
Phone (515) 432-3140

1015 Union St
Ste 119
Boone, IA 50036
Phone (515) 433-8500

12499 University Ave
Ste 210
Des Moines, IA 50325

1801 Hickman Rd
Des Moines, IA 50314
Phone (515) 282-2200

1002 S Lincoln St
Knoxville, IA 50138
Phone (641) 842-1464

1202 W Howard St
Knoxville, IA 50138
Phone (641) 828-7144

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/19659/brand/1/csg/1/fhir/r4
  • Direct secure messaging: mark.fish.1@19659.direct.athenahealth.com
  • Direct secure messaging: mfish12506@direct.unitypoint.org
  • Direct secure messaging: mfish3944518@direct.trinity-health.org

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 10

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": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358899200000",
    "number": "1548212368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12499 UNIVERSITY AVE",
            "address_2": "STE. 210",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "503258288",
            "telephone_number": "515-440-2676",
            "fax_number": "515-440-2677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12499 UNIVERSITY AVE",
            "address_2": "STE. 210",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "503258288",
            "telephone_number": "515-440-2676",
            "fax_number": "515-440-2677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISH",
        "first_name": "MARK",
        "middle_name": "DOUGLAS",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2013-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "IA",
            "license": "3790",
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "IN",
            "license": "02003044A",
            "primary": false
        },
        {
            "code": "207XS0114X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "IN",
            "license": "02003044A",
            "primary": false
        },
        {
            "code": "207XX0004X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Foot and Ankle Surgery",
            "state": "IN",
            "license": "02003044A",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "IN",
            "license": "02003044A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000480577",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME",
            "identifier": "4178250001",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7305819",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "2655165",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SIHO",
            "identifier": "075965",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00325521",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clive, IA

Sources for this page

Verify at the official NPI Registry.