Mark G Davis, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

000685 Issued in IA

Practice address

1519 S Phillips St
Algona, IA 50511-3649

Phone

(515) 295-7714

Fax

(515) 295-4505

NPI assigned

Nov 6, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IA

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: markdavis@komhn.cernerdirect.com

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594166400000",
    "number": "1760561963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1519 S PHILLIPS ST",
            "city": "ALGONA",
            "state": "IA",
            "postal_code": "505113649",
            "telephone_number": "515-295-7714",
            "fax_number": "515-295-4505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1519 S PHILLIPS ST",
            "city": "ALGONA",
            "state": "IA",
            "postal_code": "505113649",
            "telephone_number": "515-295-7714",
            "fax_number": "515-295-4505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "MARK",
        "middle_name": "G",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-06",
        "last_updated": "2020-07-08",
        "certification_date": "2020-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IA",
            "license": "000685",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK",
            "identifier": "06226",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK",
            "identifier": "36655",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "MarkDavis@komhn.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Kossuth Regional Health Center Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "1519 S Phillips St",
            "city": "Algona",
            "state": "IA",
            "country_code": "US",
            "postal_code": "505113649",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Harry M Condoleon, DO
• County of Kossuth
• Ashley Lynn Courtney, LMFT
• Joleen Crook Frideres, LMHC
• Kimberly Marie Dahlhauser
• Kathy Ann Dearchs, LISW
• Donald J Kingfield
• Jeffrey John Doolittle, M.D.
• Kimberly Elizabeth Etherington, PA
• Evolve Physical Therapy, PLLC

• All providers in Algona, IA
• Medical Physician Assistant in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.