Active NPI
Mark J Devries, M.D.
- Family Medicine Physician
- Taylorsville, NC
National Provider Identifier
1679507164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 9901160
- 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
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 |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8912288 | Medicaid | NC |
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
- 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
| License | State | Type | Specialty |
|---|---|---|---|
| 9901160 | NC | MD | Family 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 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.