NPIMap

Individual provider Active NPI

Mark Fenzl, MD

  • Diagnostic Radiology Physician
  • Springville, NY
National Provider Identifier
1710958780
Registry record updated Apr 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
179483 Issued in NY
Practice address
224 E Main St
Springville, NY 14141-1443
Phone
(716) 592-2871
NPI assigned
Jan 30, 2006
Last updated
Apr 23, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 179483 NY Primary

Addresses

Primary practice location

224 E Main St
Springville, NY 14141-1443

Mailing address

PO Box 1314
Orchard Park, NY 14127-8314
Phone (716) 535-0741

Other identifiers 1

IdentifierTypeStateIssuer
01560085MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, PA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040430000429 NY Practitioner - Diagnostic Radiology 9931011566 Reassigns benefits to 5 organizations
I20200205001772 PA Practitioner - Diagnostic Radiology 9931011566

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

224 E Main St
Springville, NY 14141-1443
Phone (716) 535-0741

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St Lawrence Radiology Assoc PC Diagnostic Radiology CurrentSince Mar 16, 2019 Accepting new patients
Southtowns Radiology Associates, LLC Diagnostic Radiology CurrentSince May 28, 2019 Accepting new patients
Olean Radiology, PC Diagnostic Radiology CurrentSince Mar 9, 2019 Accepting new patients
Juniper Radiology, PC Diagnostic Radiology CurrentSince Apr 4, 2007 Accepting new patients
Imaging Subspecialist of New York Past Accepting new patients
Nuclear Medicine Associates RLLP Past Accepting new patients
Southtowns Radiology Associates, LLC Diagnostic Radiology Past Accepting new patients
Great Lakes Physician Practice PC PastSince Sep 19, 2017 Accepting new patients

Locations

8395 Oswego Rd
Baldwinsville, NY 13027
Phone (315) 450-4898

2157 Main St
Buffalo, NY 14214
Phone (716) 862-1501

565 Abbott Rd
Buffalo, NY 14220
Phone (716) 826-7000

140 W Main St
Cuba, NY 14727
Phone (585) 968-2000

529 Central Ave
Dunkirk, NY 14048
Phone (716) 338-9797

77 W Barney St
Gouverneur, NY 13642
Phone (315) 287-1000

3040 Amsdell Rd
Hamburg, NY 14075
Phone (716) 646-6700

4 Johnson Rd
Latham, NY 12110
Phone (518) 220-2080

1 Hospital Dr
Massena, NY 13662
Phone (315) 764-1711

110 Crystal Run Rd
Middletown, NY 10941
Phone (845) 673-6446

4693 Commercial Dr
New Hartford, NY 13413
Phone (315) 507-5114

515 Main St
Olean, NY 14760
Phone (716) 373-2600

535 Main St
Olean, NY 14760
Phone (716) 372-0141

321 Genesee St
Oneida, NY 13421
Phone (315) 361-2020

3669 Southwestern Blvd
Orchard Park, NY 14127
Phone (716) 662-0500

50 Leroy St
Potsdam, NY 13676
Phone (315) 261-6034

224 E Main St
Springville, NY 14141
Phone (716) 592-2871

1014 Oswegatchie Trail Rd
Star Lake, NY 13690
Phone (315) 848-3351

1116 Arsenal St
Ste 504
Watertown, NY 13601
Phone (315) 782-2669

Organizations & group practices 9

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587600000000",
    "number": "1710958780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1314",
            "city": "ORCHARD PARK",
            "state": "NY",
            "postal_code": "141278314",
            "telephone_number": "716-535-0741",
            "fax_number": "716-650-5745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 E MAIN ST",
            "city": "SPRINGVILLE",
            "state": "NY",
            "postal_code": "141411443",
            "telephone_number": "716-592-2871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENZL",
        "first_name": "MARK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-30",
        "last_updated": "2020-04-23",
        "certification_date": "2020-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "179483",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01560085",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springville, NY

Sources for this page

Verify at the official NPI Registry.