Mark R. Dvorak, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

104604-030 Issued in WI

Practice address

N2950 State Road 67
Lake Geneva, WI 53147-2655

Phone

(262) 245-4990

Fax

(262) 245-2248

NPI assigned

Dec 13, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy Health System CorporationGroup PAC ID 7416860440, shared by 14 NPIs, 749 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Walworth Hospital & Medical Center Hospital, Lake Geneva, WI, CCN 521357

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mdvorak5750@direct.mhemail.org

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.

• Mercy Health System Corporation

  • Multi-Specialty Clinic/Center
  • Janesville, WI
  • NPI 1598718603
  Medicare reassignment
• Mercy Health System Corporation

  • Critical Access Hospital
  • Lake Geneva, WI
  • NPI 1699728550
  Medicare reassignment
• Mercy Health System Corporation

  • General Acute Care Hospital
  • Janesville, WI
  • NPI 1093768962
  NPD
• Southeastern Wisconsin Anesthesiology, S.C.

  • Anesthesiology Physician
  • Burlington, WI
  • NPI 1639125701
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mercy Health System Corporation

  • Critical Access Hospital
  • Lake Geneva, WI
  • NPI 1699728550
  Care Compare affiliation

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

{
    "created_epoch": "1134432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465776000000",
    "number": "1699750661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N2950 STATE ROAD 67",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531472655",
            "telephone_number": "262-245-4990",
            "fax_number": "262-245-2248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N2950 STATE ROAD 67",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531472655",
            "telephone_number": "262-245-4990",
            "fax_number": "262-245-2248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DVORAK",
        "first_name": "MARK",
        "middle_name": "R.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-13",
        "last_updated": "2016-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WI",
            "license": "104604-030",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "1149-33",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1699750661",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43372600",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MERCYCARE INSURANCE",
            "identifier": "DVORAMAR",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "430067408",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Michael Disabato Jr.
• Discovering Pathways Inc
• Millicent Joanna Doud, NURSE PRACTITIONER
• Madalyn R Douglas, DPT
• Dr. Daniel Bishop
• E Bruns Foot and Ankle SC
• E. Bruns Foot & Ankle, SC
• E.a. McCullough, Inc.
• Erika Eiesland, PT, DPT
• Dina A Eisel, LPN

• Certified Registered Nurse Anesthetist in Lake Geneva, WI
• Providers in Lake Geneva, WI by specialty
• Certified Registered Nurse Anesthetist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.