Mark David Antenucci, D.P.M
Individual provider Active NPI Podiatrist · Roswell, NM
NPI 1760490759 · NPPES record last updated Jun 24, 2009
Key facts
- NPI
- 1760490759
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Podiatrist 213E00000X
- License
- 184 (NM)
- Practice address
- 313 West Country Club Rd.
Ste. 7
Roswell, NM 88201 - Phone
- (575) 624-2398
- Fax
- (575) 624-0655
- NPI assigned
- Aug 4, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Podiatry
- Education
- Other, 1984
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
313 W Country Club Rd
Suite 7
Roswell, NM 88201-5804
Phone (575) 624-2398
Merit-based Incentive Payment System (MIPS)
- Final score
- 0 of 100
- Quality
- 0
- Improvement activities
- 0
- Cost
- 0
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 1-10 |
| Removal of nail tissue | 530 |
| Removal or shaving of skin growth | 368 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061010000738 | NM | Practitioner - Podiatry | 0446254346 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 184 | NM | MD | Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mark D Antenucci DPM PC | Podiatrist | Current |
Accepting new patients |
Locations
313 W Country Club Rd
Ste 7
Roswell, NM 88201
Phone (505) 624-2398
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 184 | NM | Yes |
Addresses
Primary practice location
313 West Country Club Rd.
Ste. 7
Roswell, NM 88201
Mailing address
313 West Country Club Rd.
Ste. 7
Roswell, NM 88201
Phone (575) 624-2398
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 55657 | Medicaid | NM |
Other providers in Roswell, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 24, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.