NPIMap

Individual provider Active NPI

Mark David Richardson, M.D.

  • Family Medicine Physician
  • Marshall, MI
National Provider Identifier
1669449443
Registry record updated Mar 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301047635 Issued in MI
Practice address
215 E Mansion St
Suite 1E
Marshall, MI 49068-1559
Phone
(269) 781-3938
NPI assigned
Mar 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301047635 MI Primary

Addresses

Primary practice location

215 E Mansion St
Suite 1E
Marshall, MI 49068-1559

Mailing address

215 E Mansion St
Suite 1E
Marshall, MI 49068-1559
Phone (269) 781-3938

Other identifiers 1

IdentifierTypeStateIssuer
2895802MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20100612000069 MI Practitioner - Family Practice 9133259401 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wayne State University School of Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West Front Primary Care PLLCGroup PAC ID 4183514706, 20 clinicians
Great Lakes Therapy Housecalls PCGroup PAC ID 7719876580, shared by 2 NPIs, 71 clinicians

Practice addresses (Care Compare)

4290 Copper Ridge Dr
Suite 200
Traverse City, MI 49684-7205
Phone (231) 935-8930

9731 E Cherry Bend Rd
Traverse City, MI 49684-7621
Phone (231) 941-8100

Hospital & facility affiliations

  • Munson Home Care Home health agency, Traverse City, MI, CCN 237025
  • Great Lakes Home Healthcare Specialists LLC Home health agency, Traverse City, MI, CCN 239304
  • Munson Medical Center Hospital, Traverse City, MI, CCN 230097
  • Paul Oliver Memorial Hospital Hospital, Frankfort, MI, CCN 231300
  • Munson Healthcare Cadillac Hospital Hospital, Cadillac, MI, CCN 230081

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
West Front Primary Care, P.L.L.C. Family Medicine CurrentSince May 1, 2016 Accepting new patients
Munson Medical Center Current Accepting new patients
Munson Medical Center Family Medicine CurrentSince Nov 8, 2017 Accepting new patients
West Front Primary Care, P.L.L.C. Family Medicine PastSince May 1, 2016 Accepting new patients

Locations

2513 Momentum Pl
Chicago, IL 60689
Phone (231) 935-8031

3537 W Front St
Ste E
Traverse City, MI 49684
Phone (231) 935-5880

1400 Medical Campus Dr
Traverse City, MI 49684
Phone (231) 935-8000

550 Munson Ave
Traverse City, MI 49686
Phone (231) 935-6600

4290 Copper Ridge Dr
Ste 200
Traverse City, MI 49684
Phone (231) 935-8930

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

Interoperability endpoints

  • Direct secure messaging: mark.richardson.p1@direct.wfpc.nextgenshare.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1141171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458000000000",
    "number": "1669449443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 E MANSION ST",
            "address_2": "SUITE 1E",
            "city": "MARSHALL",
            "state": "MI",
            "postal_code": "490681559",
            "telephone_number": "269-781-3938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 E MANSION ST",
            "address_2": "SUITE 1E",
            "city": "MARSHALL",
            "state": "MI",
            "postal_code": "490681559",
            "telephone_number": "269-781-3938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "MARK",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-01",
        "last_updated": "2016-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301047635",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2895802",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marshall, MI

Sources for this page

Verify at the official NPI Registry.