Mark David Pell, DPM
Individual provider Active NPI Foot & Ankle Surgery Podiatrist · Southgate, KY
NPI 1639433261 · NPPES record last updated Feb 24, 2025
Key facts
- NPI
- 1639433261
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Foot & Ankle Surgery Podiatrist 213ES0103X
- License
- 243972 (KY)
- Practice address
- 525 Alexandria Pike
Southgate, KY 41071-3290 - Phone
- (859) 212-0175
- Fax
- (859) 441-3698
- NPI assigned
- Jun 28, 2012
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 13
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Podiatry
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Summit Medical Group Inc
Practice addresses (Care Compare)
1500 James Simpson Jr Way
Covington, KY 41011-0800
Phone (859) 655-4111
Hospital & facility affiliations
- St Elizabeth Edgewood
- St Elizabeth Ft Thomas
- St Elizabeth Florence
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.01 of 100
- Quality
- 86.02
- Promoting interoperability
- 100
- Improvement activities
- 40
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 43 |
| Removal of skin lesions | 1-10 |
| Removal of nail tissue | 466 |
| Removal or shaving of skin growth | 30 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in PA, KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150825002812 | PA | Practitioner - Podiatry | 5193031912 | Reassigns benefits to 1 organization |
| I20200113000193 | KY | Practitioner - Podiatry | 5193031912 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 243972 | KY | MD | Foot & Ankle Surgery Podiatrist |
| SC006335 | PA | MD | Foot & Ankle Surgery Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bryn Mawr Foot & Ankle Center, LLC | Current |
Accepting new patients | |
| Summit Medical Group, Inc | Foot & Ankle Surgery | Current |
Accepting new patients |
| Summit Medical Group, Inc. | Foot & Ankle Surgery | Current |
Accepting new patients |
| Integrated Foot and Ankle Specialists of PA LLC | Foot & Ankle Surgery | Past |
Accepting new patients |
Locations
1500 James Simpson Jr Way
Covington, KY 41011
Phone (859) 655-4353
405 Violet Rd
Crittenden, KY 41030
Phone (859) 428-1610
1980 Litton Ln
Hebron, KY 41048
Phone (859) 334-8700
200 W 3rd St
Newport, KY 41071
Phone (859) 212-0175
525 Alexandria Pike
Southgate, KY 41071
Phone (859) 212-0175
300 Barnes Rd
Williamstown, KY 41097
Phone (859) 824-8217
934 County Line Rd
Bryn Mawr, PA 19010
Phone (610) 527-3311
Interoperability endpoints
- mpell298538@direct-prd.stelizabeth.com
- mark.pell@brynmaw.ehi.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist | 213ES0103X | SC006335 | PA | |
| Foot & Ankle Surgery Podiatrist | 213ES0103X | 243972 | KY | Yes |
Addresses
Primary practice location
525 Alexandria Pike
Southgate, KY 41071-3290
Mailing address
PO Box 635283
Cincinnati, OH 45263-5283
Phone (592) 120-1758
Other practice location 1
1500 James Simpson Jr Way
Covington, KY 41011-0801
Phone (859) 212-0175
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0382069 | Medicaid | OH | |
| 7100640210 | Medicaid | KY |
NPI Registry JSON
{
"created_epoch": "1340841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1740355200000",
"number": "1639433261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 635283",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452635283",
"telephone_number": "592-120-1758",
"fax_number": "859-655-8911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "525 ALEXANDRIA PIKE",
"city": "SOUTHGATE",
"state": "KY",
"postal_code": "410713290",
"telephone_number": "859-212-0175",
"fax_number": "859-441-3698"
}
],
"practiceLocations": [
{
"address_1": "1500 James Simpson Jr Way",
"address_purpose": "LOCATION",
"city": "Covington",
"state": "KY",
"postal_code": "410110801",
"country_code": "US",
"telephone_number": "859-212-0175",
"fax_number": "859-655-8911",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PELL",
"first_name": "MARK",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-06-28",
"last_updated": "2025-02-24",
"certification_date": "2025-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "213ES0103X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": "PA",
"license": "SC006335",
"primary": false
},
{
"code": "213ES0103X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": "KY",
"license": "243972",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0382069",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7100640210",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southgate, KY
- Northern Kentucky Foot Specialists, PSC
- Northern Kentucky Foot Specialists, PSC
- Zachary Joseph Obert
- Orthocincy
- James John Otrembiak
- River Hills Pediatrics
- Jamie Lynn Schulz
- Rebecca Jo Scott
- Mary Ann Smith
- Southgate Chiropractic Inc.
All providers in Southgate, KY · Foot & Ankle Surgery Podiatrist in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 24, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.