Individual provider Active NPI

Kevin Mark, DPT

  • Physical Therapist
  • Baltimore, MD
National Provider Identifier
1720413784
Registry record updated Aug 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
24735 Issued in MD
Practice address
6500 Eastern Ave
Ste E&F
Baltimore, MD 21224-2900
Phone
(410) 633-3670
Fax
(410) 633-3674
NPI assigned
Sep 10, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 036727 NY
Physical Therapist 225100000X 24735 MD Primary

Addresses

Primary practice location

6500 Eastern Ave
Ste E&F
Baltimore, MD 21224-2900

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2223

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20151002000071 MD Practitioner - Physical Therapist in Private Practice 5890003362 Reassigns benefits to 3 organizations
I20180517002192 DC Practitioner - Physical Therapist in Private Practice 5890003362 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

8322 Bellona Ave
Suite 100
Towson, MD 21204-2065
Phone (410) 337-8847

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
24735MDMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ati Holdings, LLC Physical Therapist CurrentSince Aug 6, 2015 Accepting new patients
University of Maryland Medical Regional Professional Services, LLC Physical Therapist CurrentSince Aug 3, 2020 Accepting new patients
University of Maryland Medical Regional Professional Services, LLC Physical Therapist CurrentSince Aug 3, 2020 Accepting new patients
Ati Holdings, LLC Physical Therapist CurrentSince Aug 6, 2015 Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

4947 Paysphere Cir
Chicago, IL 60674
Phone (630) 783-2001

6500 Eastern Ave
Ste E
Baltimore, MD 21224
Phone (410) 633-3670

1510 Rock Spring Rd
Ste C
Forest Hill, MD 21050
Phone (410) 420-3619

900 Elkridge Landing Rd
Fl 2
Linthicum Heights, MD 21090
Phone (443) 462-5010

52 Rising Sun Town Ctr
Rising Sun, MD 21911
Phone (410) 658-0100

192 Halpine Rd
Ste D
Rockville, MD 20852
Phone (240) 514-2400

2420 N Salisbury Blvd
Unit 5
Salisbury, MD 21801
Phone (410) 546-4952

11271 New Hampshire Ave
Silver Spring, MD 20904
Phone (240) 485-1280

8322 Bellona Ave
Rm 100
Towson, MD 21204
Phone (410) 337-7900

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1378771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440633600000",
    "number": "1720413784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6500 EASTERN AVE",
            "address_2": "STE E&F",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212242900",
            "telephone_number": "410-633-3670",
            "fax_number": "410-633-3674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARK",
        "first_name": "KEVIN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-09-10",
        "last_updated": "2015-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "036727",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "24735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2015; 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.