Mark Lee Pemberton, PAC

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

1500212 Issued in KS

Practice address

7450 Kessler St Ste 202
Shawnee Mission, KS 66204-2553

Phone

(913) 632-9480

Fax

(913) 632-9499

NPI assigned

Mar 29, 2006

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742428800000",
    "number": "1669433652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7450 KESSLER ST STE 202",
            "city": "SHAWNEE MISSION",
            "state": "KS",
            "postal_code": "662042553",
            "telephone_number": "913-632-9480",
            "fax_number": "913-632-9499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7450 KESSLER ST STE 202",
            "city": "SHAWNEE MISSION",
            "state": "KS",
            "postal_code": "662042553",
            "telephone_number": "913-632-9480",
            "fax_number": "913-632-9499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEMBERTON",
        "first_name": "MARK",
        "middle_name": "LEE",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-29",
        "last_updated": "2025-03-20",
        "certification_date": "2025-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "KS",
            "license": "1500212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lori C. Patterson, CRNA
• Ann Elizabeth Pattin, MD
• Lisa Ann Pazdernik, M.D.
• Simone Pearl
• Heidi Louise Peck, PA
• Elijah M Penny, CRNA
• Tiana J Penny, CRNA
• Brant Peoples, PHARMD
• John Evaristo Perez III, MD
• Joseph B Petelin, M.D.

• All providers in Shawnee Mission, KS
• Surgical Physician Assistant in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.