Mark Tye Haeberle

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

47890 Issued in KY

Practice address

3810 Springhurst Blvd
Suite 200
Louisville, KY 40241

Phone

(502) 583-1749

Fax

(502) 329-8184

NPI assigned

Apr 4, 2011

Last updated

Jul 17, 2018By the provider in NPPES

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 KY, IN2 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

Specialty

Dermatology

Education

University of Louisville School of Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Associates in Dermatology, PLLCGroup PAC ID 1658263876, 37 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Spring View Hospital Hospital, Lebanon, KY, CCN 180024

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Associates in Dermatology, PLLC

  • Dermatology Physician
  • Louisville, KY
  • NPI 1629083399

  IN

  Medicare reassignment Care Compare group NPD
• University of Louisville Physicians, Inc.

  • Internal Medicine Physician
  • Louisville, KY
  • NPI 1366722316

  Dermatology

  Medicare reassignment NPD
• University of Louisville Physicians, Inc.

  dba ULP Radiological Associates

  • Diagnostic Radiology Physician
  • Louisville, KY
  • NPI 1316294127
  NPD
• University of Louisville Physicians, Inc.

  dba ULP Gynecology Oncology

  • Gynecologic Oncology Physician
  • Louisville, KY
  • NPI 1467727586
  NPD

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

• Spring View Hospital LLC

  dba Spring View Hospital

  • Rural Acute Care Hospital
  • Lebanon, KY
  • NPI 1780746420
  Care Compare affiliation

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

{
    "created_epoch": "1301875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531785600000",
    "number": "1558650291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 950132",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402950132",
            "telephone_number": "888-980-8992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3810 SPRINGHURST BLVD",
            "address_2": "SUITE 200",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40241",
            "telephone_number": "502-583-1749",
            "fax_number": "502-329-8184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAEBERLE",
        "first_name": "MARK",
        "middle_name": "TYE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-04",
        "last_updated": "2018-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "KY",
            "license": "47890",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100215390",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jamila Hadden, LPCC
• Mohiuddin Hadi, MBBS,MD
• Reza Hadioonzadeh, DDS
• Maria Hadjisavva
• Terence J Hadley, M.D.
• Meredith Haedtler
• Kathryn Lynn Haendiges, PSY.D.
• Julie Hafendorfer, R.N
• Hafendorfer, PLLC (Kenneth A Hafendorfer MD)
• Chloe Ruth Haffley, PMHNP

• Dermatology Physician in Louisville, KY
• Providers in Louisville, KY by specialty
• Dermatology Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.