Individual provider Active NPI

Mark Evan Demuth, D.O.

  • Family Medicine Physician
  • Clarkson, KY
National Provider Identifier
1619031192
Registry record updated Mar 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
03097 Issued in KY
Practice address
619 W Main St
Clarkson, KY 42726-7044
Phone
(186) 665-3823
NPI assigned
Dec 20, 2006
Last updated
Mar 9, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036110355 IL
Family Medicine Physician 207Q00000X 03097 KY Primary

Addresses

Primary practice location

619 W Main St
Clarkson, KY 42726-7044

Mailing address

1342 Amandajo Dr
Elizabethtown, KY 42701-4629
Phone (270) 307-1114

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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 1

Enrollment IDStateProvider typePAC IDDetails
I20081023000259 KY Practitioner - Family Practice 7618035411 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Mid West Medical College, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Owensboro Health, IncGroup PAC ID 0547154650, shared by 9 NPIs, 179 clinicians
Baptist Health Medical Group IncGroup PAC ID 5597867184, 2,431 clinicians

Practice addresses (Care Compare)

1006 Ford Ave
Owensboro, KY 42301-4677
Phone (270) 688-4845

1111 Ring Rd
Elizabethtown, KY 42701-4900
Phone (270) 706-1111

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.29 of 100Reported as apm
Quality
87.32
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036110355ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Health Medical Group Inc CurrentSince Sep 1, 2020 Accepting new patients
Baptist Health Medical Group Inc CurrentSince Sep 1, 2020 Accepting new patients

Locations

1009 N Mulberry St
Elizabethtown, KY 42701
Phone (270) 979-7109

1111 Ring Rd
Elizabethtown, KY 42701
Phone (270) 706-1111

3900 Kresge Way
Ste 41
Louisville, KY 40207
Phone (502) 896-1313

1360 Rogersville Rd
Radcliff, KY 40160
Phone (270) 351-1150

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 2

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": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236556800000",
    "number": "1619031192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1342 AMANDAJO DR",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427014629",
            "telephone_number": "270-307-1114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 W MAIN ST",
            "city": "CLARKSON",
            "state": "KY",
            "postal_code": "427267044",
            "telephone_number": "186-665-3823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMUTH",
        "first_name": "MARK",
        "middle_name": "EVAN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-20",
        "last_updated": "2009-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036110355",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "03097",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarkson, KY

Sources for this page

Verify at the official NPI Registry.