Individual provider Active NPI

Mark D Sherrard, D.O.

  • Family Medicine Physician
  • Monroe, MI
National Provider Identifier
1790781300
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101008675 Issued in MI
Practice address
718 N Macomb St
Monroe, MI 48162-7815
Phone
(734) 240-8927
Fax
(734) 240-4424
NPI assigned
Jun 28, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5101008675 MI Primary

Addresses

Primary practice location

718 N Macomb St
Monroe, MI 48162-7815

Mailing address

1 Seagate # 800
Toledo, OH 43604-1558
Phone (734) 240-8927

Other practice location 1

1397 N Monroe St
Monroe, MI 48162-5360
Phone (734) 243-3420

Other identifiers 1

IdentifierTypeStateIssuer
4332448MedicaidMI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address msherrard30579@epicdirect.promedica.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20140221000940 MI Practitioner - Family Practice 5496937476 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Osteopathic Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Promedica Monroe PhysiciansGroup PAC ID 2365696176, 64 clinicians

Practice addresses (Care Compare)

718 N Macomb St
Monroe, MI 48162-7815
Phone (734) 240-8987

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101008675MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Monroe Physicians Family Medicine CurrentSince Apr 1, 2020 Accepting new patients
Mercy Memorial Hospital Corporatio CurrentSince Aug 27, 2020 Accepting new patients

Locations

3175 Smith Rd
Lambertville, MI 48144
Phone (734) 856-5494

905 N Macomb St
Ste 2
Monroe, MI 48162
Phone (734) 242-1899

718 N Macomb St
Monroe, MI 48162
Phone (734) 212-3097

650 Stewart Rd
Monroe, MI 48162
Phone (734) 240-4594

100 Madison Ave
Toledo, OH 43604
Phone (567) 585-1964

Organizations & group practices 2

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": "1119916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1790781300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SEAGATE # 800",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436041558",
            "telephone_number": "734-240-8927",
            "fax_number": "734-240-4424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "718 N MACOMB ST",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481627815",
            "telephone_number": "734-240-8927",
            "fax_number": "734-240-4424"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1397 N Monroe St",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "MI",
            "postal_code": "481625360",
            "country_code": "US",
            "telephone_number": "734-243-3420",
            "fax_number": "734-457-4570",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHERRARD",
        "first_name": "MARK",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-28",
        "last_updated": "2023-11-03",
        "certification_date": "2020-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101008675",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4332448",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "msherrard30579@epicdirect.promedica.org",
            "affiliation": "N",
            "address_1": "100 Madison Ave",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436041516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Monroe, MI

Sources for this page

Verify at the official NPI Registry.