Individual provider Active NPI

Mark David Rostash

  • Gerontology Nurse Practitioner
  • Lebanon, NH
National Provider Identifier
1780222158
Registry record updated Sep 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
116942-23 Issued in NH
Practice address
1 Medical Center Dr
Lebanon, NH 03756-0001
Phone
(603) 650-5000
NPI assigned
Dec 17, 2019
Last updated
Sep 10, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2026

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 235645 AZ
Acute Care Nurse Practitioner 363LA2100X APRN-3542 HI
Critical Care Medicine Nurse Practitioner 363LC0200X 235645 AZ
Gerontology Nurse Practitioner 363LG0600X 116942-23 NH Primary

Addresses

Primary practice location

1 Medical Center Dr
Lebanon, NH 03756-0001

Mailing address

PO Box 810
Hanover, NH 03755-0810
Phone (603) 308-1467

Other practice location 1

5301 E Grant Rd
Tucson, AZ 85712-2805
Phone (520) 324-5461

Other practice location 2

1301 Punchbowl St
Honolulu, HI 96813-2499
Phone (808) 691-1000

Other identifiers 1

IdentifierTypeStateIssuer
092349MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, HI2 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
I20200929002029 AZ Practitioner - Nurse Practitioner 9537588280 Reassigns benefits to 3 organizations
I20220607000770 HI Practitioner - Nurse Practitioner 9537588280 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Queens University Medical GroupGroup PAC ID 2466831557, 614 clinicians

Practice addresses (Care Compare)

1301 Punchbowl St
Honolulu, HI 96813-2499

1380 Lusitana St
Honolulu, HI 96813-2448

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN-3542HIMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tucson Medical Center CurrentSince Aug 1, 2020 Accepting new patients
The Queens Medical Center CurrentSince Jun 13, 2022 Accepting new patients
The Queen's Medical Center Current Accepting new patients
TMC Medical Network CurrentSince Aug 1, 2021 Accepting new patients
Queens University Medical Group CurrentSince Jul 1, 2022 Accepting new patients
The Queens Medical Center CurrentSince Jun 13, 2022 Accepting new patients
Sound Physicians Intensivists of Arizona, Inc Nurse Practitioner CurrentSince May 1, 2021 Accepting new patients
Tucson Medical Center CurrentSince Aug 1, 2020 Accepting new patients
John J Cogan MD Inc Past Accepting new patients
Tucson Medical Center Past Accepting new patients

Locations

1601 W Saint Marys Rd
Tucson, AZ 85745
Phone (520) 622-5833

2380 N Ferguson Ave
Ste 104
Tucson, AZ 85712
Phone (520) 324-1010

350 N Wilmot Rd
Tucson, AZ 85711
Phone (520) 873-3000

5301 E Grant Rd
Tucson, AZ 85712
Phone (520) 324-1344

1301 Punchbowl St
Honolulu, HI 96813
Phone (808) 538-9011

1380 Lusitana St
Ste 913
Honolulu, HI 96813
Phone (808) 691-8521

550 S Beretania St
Ste 404
Honolulu, HI 96813
Phone (808) 691-8897

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 1

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": "1576540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788998400000",
    "number": "1780222158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 810",
            "city": "HANOVER",
            "state": "NH",
            "postal_code": "037550810",
            "telephone_number": "603-308-1467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER DR",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037560001",
            "telephone_number": "603-650-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5301 E Grant Rd",
            "address_purpose": "LOCATION",
            "city": "Tucson",
            "state": "AZ",
            "postal_code": "857122805",
            "country_code": "US",
            "telephone_number": "520-324-5461",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1301 Punchbowl St",
            "address_purpose": "LOCATION",
            "city": "Honolulu",
            "state": "HI",
            "postal_code": "968132499",
            "country_code": "US",
            "telephone_number": "808-691-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSTASH",
        "first_name": "MARK",
        "middle_name": "DAVID",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-12-17",
        "last_updated": "2026-09-10",
        "certification_date": "2026-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AZ",
            "license": "235645",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "HI",
            "license": "APRN-3542",
            "primary": false
        },
        {
            "code": "363LC0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Critical Care Medicine",
            "state": "AZ",
            "license": "235645",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NH",
            "license": "116942-23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "092349",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, NH

Sources for this page

Verify at the official NPI Registry.