Individual provider Active NPI

Douglas Michael Marks, PA-C

  • Physician Assistant
  • Evansville, IN
National Provider Identifier
1760115125
Registry record updated Jul 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10005118A Issued in IN
Practice address
600 Mary St
Evansville, IN 47710-1658
Phone
(812) 450-3405
NPI assigned
Jul 5, 2022
Last updated
Jul 22, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 22, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 10005118A IN Primary
Medical Physician Assistant 363AM0700X PA

Addresses

Primary practice location

600 Mary St
Evansville, IN 47710-1658

Mailing address

600 Mary St
Evansville, IN 47710-1658
Phone (812) 450-3405

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, KY2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20250524000148 PA Practitioner - Physician Assistant 7416476221 Reassigns benefits to 1 organization
I20260612003440 KY Practitioner - Physician Assistant 7416476221 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Wisconsin School of Medicine, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

401 N Spring Mill Rd
Villanova, PA 19085-1925

500 W Jefferson St
Louisville, KY 40202-2823

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Hospital, Inc Physician Assistant Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1656979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784678400000",
    "number": "1760115125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 MARY ST",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477101658",
            "telephone_number": "812-450-3405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 MARY ST",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477101658",
            "telephone_number": "812-450-3405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARKS",
        "first_name": "DOUGLAS",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-07-05",
        "last_updated": "2026-07-22",
        "certification_date": "2026-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10005118A",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.