Individual provider Active NPI

Mark G Bandyk, MD

  • Urology Physician
  • Lakeland, FL
National Provider Identifier
1790778009
Registry record updated Jul 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
ME89653 Issued in FL
Practice address
3525 Lakeland Hills Blvd
Lakeland, FL 33805-1965
Phone
(863) 603-6565
Fax
(863) 904-1961
NPI assigned
Aug 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X ME89653 FL Primary

Addresses

Primary practice location

3525 Lakeland Hills Blvd
Lakeland, FL 33805-1965

Mailing address

1324 Lakeland Hills Blvd
Attn: Medical Staff Office
Lakeland, FL 33805-4543

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040712000826 FL Practitioner - Urology 2062323496 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
George Washington University School of Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Florida Jacksonville Physicians, Inc.Group PAC ID 9133025869, 908 clinicians

Practice addresses (Care Compare)

655 W 8TH St
Jacksonville, FL 32209-6511
Phone (904) 244-3273

Hospital & facility affiliations

  • Shands Jacksonville Hospital, Jacksonville, FL, CCN 100001

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME89653FLMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Florida Jacksonville Physicians Inc CurrentSince Oct 10, 2016 Accepting new patients
University of Florida Jacksonville Physicians, Inc. Current Accepting new patients
University of Florida Jacksonville Physicians, Inc. CurrentSince Oct 10, 2016 Accepting new patients
Piedmont Day Surgery Center Inc Past Accepting new patients
Danville Urologic Clinic Inc Urology Past Accepting new patients
Lakeland Regional Medical Center, Inc. Past Accepting new patients

Locations

15255 Max Leggett Pkwy
Ste 4900
Jacksonville, FL 32218
Phone (904) 244-3406

15255 Max Leggett Pkwy
Ste 3100
Jacksonville, FL 32218
Phone (904) 383-1015

655 W 8th St
Jacksonville, FL 32209
Phone (904) 244-1680

653 W 8th St
Fl 2
Jacksonville, FL 32209
Phone (904) 244-7281

76011 William Burgess Blvd
Fl 2
Yulee, FL 32097

Interoperability endpoints

  • Direct secure messaging: mbandyk227210@direct.shands.ufl.edu

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1124755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438128000000",
    "number": "1790778009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1324 LAKELAND HILLS BLVD",
            "address_2": "ATTN: MEDICAL STAFF OFFICE",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338054543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3525 LAKELAND HILLS BLVD",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338051965",
            "telephone_number": "863-603-6565",
            "fax_number": "863-904-1961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANDYK",
        "first_name": "MARK",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-23",
        "last_updated": "2015-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "FL",
            "license": "ME89653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

Verify at the official NPI Registry.