Mark Diaz III, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4404-23 Issued in WI

Practice address

77 S Oakbridge CT Apt 105
Madison, WI 53717-2030

Phone

(562) 659-3459

NPI assigned

Jun 20, 2018

Last updated

Jun 20, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mark.diaz@direct.milebluff.com

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.

• Mile Bluff Medical Center Inc

  dba Mile Bluff ER/UC Providers

  • Emergency Medicine Physician
  • Mauston, WI
  • NPI 1609912005

  Physician Assistant

  Medicare reassignment NPD
• Emergency Medicine Associates of Madison, SC

  • Emergency Medicine Physician
  • Madison, WI
  • NPI 1235119769
  Medicare reassignment
• Mile Bluff Medical Center Inc

  dba Mile Bluff Urgent Care

  • Urgent Care Clinic/Center
  • Mauston, WI
  • NPI 1437958683
  NPD
• Mile Bluff Medical Center Inc

  dba Mile Bluff Mauston Clinic

  • Rural Health Clinic/Center
  • Mauston, WI
  • NPI 1881930527
  NPD

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

{
    "created_epoch": "1529452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529452800000",
    "number": "1700370020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 S OAKBRIDGE CT APT 105",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537172030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 S OAKBRIDGE CT APT 105",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537172030",
            "telephone_number": "562-659-3459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIAZ",
        "first_name": "MARK",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-20",
        "last_updated": "2018-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "4404-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diane Weiner PHD, L.L.C.
• Ruth A Diaz de Leon, NP
• Kelvin Diaz Perez
• Catherine Diaz, APNP
• Elizabeth G Diaz, PA-C
• Morgan Diaz, OTR/L
• Alayna Dibo, LCSW
• Lauren Elizabeth Dicalvo, DO
• Faith Dickerson, MD
• Laura Elizabeth Dickman, BSW

• Physician Assistant in Madison, WI
• Providers in Madison, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.