Individual provider Active NPI

Mark E Mailliard, MD

  • Gastroenterology Physician
  • Omaha, NE
National Provider Identifier
1699725036
Registry record updated Jun 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
15950 Issued in NE
Practice address
988102 Nebraska Medical Ctr
Omaha, NE 68198-8102
Phone
(402) 559-4015
Fax
(402) 559-8715
NPI assigned
May 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 15950 NE Primary

Addresses

Primary practice location

988102 Nebraska Medical Ctr
Omaha, NE 68198-8102

Mailing address

988102 Nebraska Medical Ctr
Omaha, NE 68198-8102
Phone (402) 559-4015

Other identifiers 1

IdentifierTypeStateIssuer
47078557523MedicaidNE

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: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Clinic CurrentSince Apr 25, 2017 Accepting new patients
Unmc Physicians CurrentSince Jul 1, 1998 Accepting new patients
Sanford Medical Center CurrentSince Apr 25, 2017 Accepting new patients
Sanford Clinic Current Accepting new patients

Locations

988102 Nebraska Medical Ctr
Omaha, NE 68198
Phone (402) 559-5600

Emile 42nd St
Omaha, NE 68198
Phone (402) 552-6731

525 N Foster St
Mitchell, SD 57301
Phone (605) 995-2000

4405 E 26th St
Sioux Falls, SD 57103
Phone (605) 328-9000

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.

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308787200000",
    "number": "1699725036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "988102 NEBRASKA MEDICAL CTR",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681988102",
            "telephone_number": "402-559-4015",
            "fax_number": "402-559-8715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "988102 NEBRASKA MEDICAL CTR",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681988102",
            "telephone_number": "402-559-4015",
            "fax_number": "402-559-8715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAILLIARD",
        "first_name": "MARK",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-10",
        "last_updated": "2011-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NE",
            "license": "15950",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47078557523",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.