Individual provider Active NPI

Mark Laurel

  • Acute Care Nurse Practitioner
  • Dallas, TX
National Provider Identifier
1700417920
Registry record updated Jan 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
STUDENT Issued in TX
Practice address
3500 Gaston Ave
Dallas, TX 75246-2017
Phone
(214) 820-0111
NPI assigned
Jan 27, 2020
Last updated
Jan 27, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X STUDENT TX Primary

Addresses

Primary practice location

3500 Gaston Ave
Dallas, TX 75246-2017

Mailing address

411 Broadway Ave Apt 4421
Dallas, TX 75212-5286

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20200716001018 TX Practitioner - Nurse Practitioner 1850715426 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Healthtexas Provider NetworkGroup PAC ID 1355254210, 2,535 clinicians

Practice addresses (Care Compare)

3500 Gaston Ave
FL 1
Dallas, TX 75246-2017
Phone (972) 817-6100

4001 Worth St
Dallas, TX 75246-1608

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
STUDENTTXMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Healthtexas Provider Network CurrentSince Jun 8, 2020 Accepting new patients
Healthtexas Provider Network CurrentSince Jun 8, 2020 Accepting new patients
Healthtexas Provider Network Current Accepting new patients

Locations

3500 Gaston Ave
Dallas, TX 75246

4001 Worth St
Dallas, TX 75246
Phone (214) 828-1745

8080 N Central Expy
Ste 600
Dallas, TX 75206
Phone (469) 800-8648

Interoperability endpoints

  • Direct secure messaging: mlaurel492934@direct.sw.org

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1580083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580083200000",
    "number": "1700417920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 BROADWAY AVE APT 4421",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752125286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 GASTON AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752462017",
            "telephone_number": "214-820-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAUREL",
        "first_name": "MARK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-01-27",
        "last_updated": "2020-01-27",
        "certification_date": "2020-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "STUDENT",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.