Active NPI
Mark Lee Erickson, DDS
- General Practice Dentistry
- Anthony, KS
National Provider Identifier
1619937307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 5629
- Practice address
- 113 N Anthony Ave
Anthony, KS 67003-2007 - Phone
- (620) 842-3844
- Fax
- (620) 842-4139
- NPI assigned
- Mar 25, 2006
- Last updated
- Aug 8, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5629 | KS | Primary |
Addresses
Primary practice location
113 N Anthony Ave
Anthony, KS 67003-2007
Mailing address
113 N Anthony Ave
Anthony, KS 67003-2007
Phone (620) 842-3844
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 116666 | Other | KS | BLUE CROSS BLUE SHIELD |
| 4054684003 | Medicaid | KS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 11, 2016 through Jan 11, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5629 | KS | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Erickson & Gill, P.a. | General Practice | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344384000000",
"number": "1619937307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "113 N ANTHONY AVE",
"city": "ANTHONY",
"state": "KS",
"postal_code": "670032007",
"telephone_number": "620-842-3844"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "113 N ANTHONY AVE",
"city": "ANTHONY",
"state": "KS",
"postal_code": "670032007",
"telephone_number": "620-842-3844",
"fax_number": "620-842-4139"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ERICKSON",
"first_name": "MARK",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-25",
"last_updated": "2012-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "KS",
"license": "5629",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "116666",
"state": "KS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4054684003",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anthony, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2012; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.