NPIMap

Individual provider Active NPI

Mark Edward Smith, D.O.

  • Gastroenterology Physician
  • Woodbury, MN
National Provider Identifier
1740451525
Registry record updated Oct 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
63619 Issued in MN
Practice address
237 Radio Dr Ste 210
Woodbury, MN 55125-4478
Phone
(612) 871-1145
Fax
(612) 870-5491
NPI assigned
Mar 19, 2008
Last updated
Oct 22, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 22, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 512 NE
Gastroenterology Physician 207RG0100X 63619 MN Primary

Addresses

Primary practice location

237 Radio Dr Ste 210
Woodbury, MN 55125-4478

Mailing address

PO Box 14909
Minneapolis, MN 55414-0909
Phone (612) 871-1145

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 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
I20180822000592 MN Practitioner - Gastroenterology 6002165222 Reassigns benefits to 1 organization
I20250107000654 WI Practitioner - Gastroenterology 6002165222 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mngi Digestive Health PAGroup PAC ID 8123016557, 276 clinicians

Practice addresses (Care Compare)

237 Radio Dr
Suite 210
Woodbury, MN 55125-4478
Phone (612) 871-1145

2651 Hillcrest Dr
Suite 302
Hudson, WI 54016-9919
Phone (612) 871-1145

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy29
Upper gastrointestinal (GI) endoscopy for acid reflux24

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
63619MNMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mngi Digestive Health, P.a. Gastroenterology CurrentSince Sep 4, 2018 Accepting new patients

Locations

15700 37th Ave N
Plymouth, MN 55446
Phone (763) 577-0008

237 Radio Dr
Ste 210
Woodbury, MN 55125
Phone (612) 502-5092

2651 Hillcrest Dr
Ste 302
Hudson, WI 54016
Phone (651) 241-5290

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: mark.smithmd.p1@direct.mngastro.nextgenshare.com

Organizations & group practices 1

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 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1205884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540166400000",
    "number": "1740451525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14909",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554140909",
            "telephone_number": "612-871-1145",
            "fax_number": "612-870-5491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "237 RADIO DR STE 210",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551254478",
            "telephone_number": "612-871-1145",
            "fax_number": "612-870-5491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MARK",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-03-19",
        "last_updated": "2018-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NE",
            "license": "512",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MN",
            "license": "63619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, MN

Sources for this page

Verify at the official NPI Registry.