NPIMap

Individual provider Active NPI

Mark G Watkins, DO

  • Pediatrics Physician
  • Toledo, OH
National Provider Identifier
1770617029
Registry record updated Jun 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
5101016254 Issued in MI
Practice address
5701 Swan Creek Dr
Toledo, OH 43614-1104
Phone
(419) 490-6448
NPI assigned
Mar 16, 2007
Last updated
Jun 2, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Endocrinology Physician 2080P0205X 34-009077 OH
General Practice Physician 208D00000X 34.009077 OH
Student in an Organized Health Care Education/Training Program 390200000X 5101016254 MI
Pediatrics Physician 208000000X 5101016254 MI Primary

Addresses

Primary practice location

5701 Swan Creek Dr
Toledo, OH 43614-1104

Mailing address

5701 Swan Creek Dr
Toledo, OH 43614-1104
Phone (419) 490-6448

Other identifiers 5

IdentifierTypeStateIssuer
06807OtherOHPARAMOUNT
1770617029MedicaidMI
9666061OtherOHAETNA
000000547496OtherOHANTHEM
2801187MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071205000422 OH Practitioner - Pediatric Medicine 6103915632 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Kansas City University of Med & Biosciences, College of Osteo Med, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

930 S Detroit Ave
Toledo, OH 43614-2701
Phone (419) 381-1881

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.01 of 100Reported as group
Quality
78.82
Promoting interoperability
100
Improvement activities
40
Cost
84.55

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34-009077OHMDPediatric Endocrinology Physician
5101016254MIMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
State of Ohio Office of Budget and Management State Accounting Current Accepting new patients
State of Ohio Office of Budget and Management State Accounting CurrentSince Jun 1, 2025 Accepting new patients
Theoria Medical CurrentSince Jul 12, 2024 Accepting new patients
Ameriwound LLC CurrentSince Jun 20, 2024 Accepting new patients
State of Ohio Office of Budget and Management State Accounting CurrentSince Jun 1, 2025 Accepting new patients
Promedica Children's Specialists Pediatrics PastSince Jan 1, 2017 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Trilogy Healthcare of Lima II, LLC Past Accepting new patients
HCF of Wapakoneta, Inc. Past Accepting new patients
Trilogy Healthcare of Allen, LLC Past Accepting new patients

Locations

41800 W 11 Mile Rd
Ste 109
Novi, MI 48375
Phone (833) 578-2763

14095 E Center St
Burton, OH 44021
Phone (440) 834-1084

30 E Broad St
Fl 11
Columbus, OH 43215
Phone (614) 466-9930

800 Ambrose Dr
Delphos, OH 45833
Phone (419) 692-0590

6150 Parkland Blvd
Ste 225
Mayfield Hts, OH 44124

717 S 30th St
Newark, OH 43056
Phone (740) 522-1171

28546 Starbright Blvd
Perrysburg, OH 43551
Phone (419) 660-0935

6101 N Summit St
Toledo, OH 43611
Phone (419) 324-3760

930 S Detroit Ave
Toledo, OH 43614
Phone (419) 381-1881

555 Anthony Wayne Trl
Waterville, OH 43566
Phone (330) 720-0406

1030 High St
Worthington, OH 43085
Phone (614) 876-7356

Organizations & group practices 10

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 5

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

NPI Registry JSON

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622592000000",
    "number": "1770617029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5701 SWAN CREEK DR",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436141104",
            "telephone_number": "419-490-6448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5701 SWAN CREEK DR",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436141104",
            "telephone_number": "419-490-6448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATKINS",
        "first_name": "MARK",
        "middle_name": "G",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-16",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0205X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": "OH",
            "license": "34-009077",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "OH",
            "license": "34.009077",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "5101016254",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "5101016254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARAMOUNT",
            "identifier": "06807",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1770617029",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9666061",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000547496",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2801187",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.