Active NPI
Mark S Peckler, M.D.
- Urology Physician
- Olympia, WA
National Provider Identifier
1770511438
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- MD00019049
- Practice address
- 3525 Ensign Rd.
Suite a
Olympia, WA 98505-0001 - Phone
- (360) 456-4666
- Fax
- (360) 459-1566
- NPI assigned
- Jun 29, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | MD00019049 | WA | Primary |
Addresses
Primary practice location
3525 Ensign Rd.
Suite a
Olympia, WA 98505-0001
Mailing address
3525 Ensign Rd NE
Suite a
Olympia, WA 98506-5065
Phone (360) 456-4666
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 17815 | Other | WA | LABOR AND INDUSTRIES |
| 1789601 | Medicaid | WA | |
| T00100 | Other | WA | REGENCE |
| G001048501 | Other | WA | PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110210000599 | WA | Practitioner - Urology | 0244279610 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421798400000",
"number": "1770511438",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3525 ENSIGN RD NE",
"address_2": "SUITE A",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985065065",
"telephone_number": "360-456-4666",
"fax_number": "360-459-1566"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3525 ENSIGN RD.",
"address_2": "SUITE A",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985050001",
"telephone_number": "360-456-4666",
"fax_number": "360-459-1566"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PECKLER",
"first_name": "MARK",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-29",
"last_updated": "2015-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "WA",
"license": "MD00019049",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR AND INDUSTRIES",
"identifier": "17815",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1789601",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE",
"identifier": "T00100",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTAN",
"identifier": "G001048501",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Olympia, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2015; 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.