Mark Edwin Carlson, MD

Primary specialty

SpecialistTaxonomy code 174400000X

License

036-073115 Issued in IL

Practice address

1848 Daimler Rd
Rockford, IL 61112-1019

Phone

(815) 398-9100

Fax

(815) 986-6770

NPI assigned

Apr 25, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283817600000",
    "number": "1790741049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1848 DAIMLER RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611121019",
            "telephone_number": "815-398-9100",
            "fax_number": "815-986-6770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1848 DAIMLER RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611121019",
            "telephone_number": "815-398-9100",
            "fax_number": "815-986-6770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "MARK",
        "middle_name": "EDWIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-25",
        "last_updated": "2010-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "036-073115",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "K52428",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36073065",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Breeannon Carlson
• Jason J Carlson, D.M.D.
• Krista L Carlson, DPT
• Lynn Carlson
• Madeline Carlson, PHARMD
• Nancy J. Carlson, MD
• Samantha Rae Carlson, APRN, FNP-BC
• Tammy L Carlson, APRN
• Carmen S Jordan
• Dawn Marie Carmichael, MSED, LCPC

• Specialist in Rockford, IL
• Providers in Rockford, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.