Individual provider Active NPI

Mark J Devries, M.D.

  • Family Medicine Physician
  • Taylorsville, NC
National Provider Identifier
1679507164
Registry record updated Jul 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
9901160 Issued in NC
Practice address
1668 NC Highway 16 S
Taylorsville, NC 28681-6285
Phone
(828) 632-9736
Fax
(828) 632-9544
NPI assigned
Jul 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2012

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 9901160 NC Primary

Addresses

Primary practice location

1668 NC Highway 16 S
Taylorsville, NC 28681-6285

Mailing address

1668 NC Highway 16 S
P O Box 579
Taylorsville, NC 28681-6285
Phone (828) 632-9736

Other identifiers 1

IdentifierTypeStateIssuer
8912288MedicaidNC

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective Apr 1, 2019 through Apr 1, 2027

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9901160NCMDFamily Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343174400000",
    "number": "1679507164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1668 NC HIGHWAY 16 S",
            "address_2": "P O BOX 579",
            "city": "TAYLORSVILLE",
            "state": "NC",
            "postal_code": "286816285",
            "telephone_number": "828-632-9736",
            "fax_number": "828-632-9544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1668 NC HIGHWAY 16 S",
            "city": "TAYLORSVILLE",
            "state": "NC",
            "postal_code": "286816285",
            "telephone_number": "828-632-9736",
            "fax_number": "828-632-9544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVRIES",
        "first_name": "MARK",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2012-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "9901160",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8912288",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Taylorsville, NC

Sources for this page

Verify at the official NPI Registry.