Individual provider Active NPI

Mark Antonio Borden, M.D.

  • Pediatrics Physician
  • Tampa, FL
National Provider Identifier
1699778589
Registry record updated Mar 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME74322 Issued in FL
Practice address
4712 N Armenia Ave Ste 102
Tampa, FL 33603-2611
Phone
(813) 879-5716
Fax
(813) 877-4890
NPI assigned
May 24, 2005
Last updated
Mar 4, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME74322 FL Primary

Addresses

Primary practice location

4712 N Armenia Ave Ste 102
Tampa, FL 33603-2611

Mailing address

4712 N Armenia Ave Ste 102
Tampa, FL 33603-2611
Phone (813) 879-5716

Other identifiers 1

IdentifierTypeStateIssuer
258148500MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Mark.Borden@direct.mybaycare.org Health Information Exchange (HIE) BayCare Medical Group, Inc.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221109000607 FL Practitioner - Pediatric Medicine 6002283744 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Baycare Medical Group, Inc. Current Accepting new patients
Baycare Medical Group, Inc CurrentSince Aug 1, 2022 Accepting new patients
Baycare Medical Group, Inc. CurrentSince Aug 1, 2022 Accepting new patients
Baycare Medical Group Inc CurrentSince Jul 25, 2021 Accepting new patients
MCR Health, Inc. Past Accepting new patients
Baycare Medical Group Pediatric Walk-in, LLC Pediatrics Past Accepting new patients
Baycare Medical Group Pediatric Walk-in Care LLC Pediatrics Past Accepting new patients

Locations

2461 Enterprise Rd
Ste C
Clearwater, FL 33763
Phone (727) 725-5060

2995 Drew St
Bldg 2ND
Clearwater, FL 33759

2995 Drew St
Fl 2
Clearwater, FL 33759
Phone (727) 315-7234

6633 Forest Ave
Ste 105
New Prt Rchy, FL 34653
Phone (727) 845-4300

2506 W Virginia Ave
Tampa, FL 33607
Phone (813) 870-3720

4712 N Armenia Ave
Ste 102
Tampa, FL 33603
Phone (813) 873-1725

Interoperability endpoints

  • Direct secure messaging: mark.borden@direct.mybaycare.org

Organizations & group practices 7

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

NPI Registry JSON

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646352000000",
    "number": "1699778589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4712 N ARMENIA AVE STE 102",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336032611",
            "telephone_number": "813-879-5716",
            "fax_number": "813-877-4890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4712 N ARMENIA AVE STE 102",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336032611",
            "telephone_number": "813-879-5716",
            "fax_number": "813-877-4890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORDEN",
        "first_name": "MARK",
        "middle_name": "ANTONIO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2022-03-04",
        "certification_date": "2022-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME74322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "258148500",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Mark.Borden@direct.mybaycare.org",
            "affiliation": "Y",
            "affiliationName": "BayCare Medical Group, Inc.",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2995 Drew Street",
            "address_2": "East Bldg 2nd Floor",
            "city": "Clearwater",
            "state": "FL",
            "country_code": "US",
            "postal_code": "33759",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.