NPIMap

Individual provider Active NPI

Mark O. Carlson, M.D.

  • Internal Medicine Physician
  • Sioux City, IA
National Provider Identifier
1609837368
Registry record updated Nov 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
27247 Issued in IA
Practice address
1605 Douglas St
Sioux City, IA 51105-1109
Phone
(712) 234-1005
Fax
(712) 234-0015
NPI assigned
Mar 31, 2006
Last updated
Nov 22, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 27247 IA Primary

Addresses

Primary practice location

1605 Douglas St
Sioux City, IA 51105-1109

Mailing address

1605 Douglas St
Sioux City, IA 51105-1109
Phone (712) 234-1005

Other identifiers 4

IdentifierTypeStateIssuer
2059956MedicaidIA
IB1201001OtherIAMEDICARE PTAN
10025457800MedicaidNE
6004143MedicaidSD

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
I20061215000009 IA Practitioner - Internal Medicine 4688673908 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Minnesota Medical School, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Siouxland Adult Medicine, PLLCGroup PAC ID 3173691730, 2 clinicians

Practice addresses (Care Compare)

1605 Douglas St
Sioux City, IA 51105-1109
Phone (712) 234-1005

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
27247IAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Iowa Hospital Corporation Past Accepting new patients
St Lukes Health Resources Internal Medicine Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/23894/brand/1/csg/1/fhir/r4

Organizations & group practices 3

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 3

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": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353542400000",
    "number": "1609837368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1605 DOUGLAS ST",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511051109",
            "telephone_number": "712-234-1005",
            "fax_number": "712-234-0015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 DOUGLAS ST",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511051109",
            "telephone_number": "712-234-1005",
            "fax_number": "712-234-0015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "MARK",
        "middle_name": "O.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-31",
        "last_updated": "2012-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "27247",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2059956",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "IB1201001",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025457800",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6004143",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux City, IA

Sources for this page

Verify at the official NPI Registry.