Active NPI
Mark A Waldman, MD
- Dermatology Physician
- Louisville, KY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 35880
- Practice address
- 310 E Broadway
Ste 200
Louisville, KY 40202-1745 - Phone
- (502) 585-5249
- Fax
- (502) 585-5251
- NPI assigned
- May 23, 2005
- Last updated
- Aug 17, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 35880 | KY | Primary |
Addresses
Primary practice location
310 E Broadway
Ste 200
Louisville, KY 40202-1745
Mailing address
310 E Broadway
Ste 200
Louisville, KY 40202-1745
Phone (502) 585-5249
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Dermatology
- Education
- University of Louisville School of Medicine, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
13802 Lake Point Cir
Suite 201
Louisville, KY 40223-4219
Phone (217) 729-7868
310 E Broadway
Suite 200
Louisville, KY 40202-1745
Phone (502) 585-5249
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 11 |
| Removal of skin lesions | 1319 |
| Removal or shaving of skin growth | 21 |
| Skin biopsy | 328 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35880 | KY | MD | Dermatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vitalskin Medical Group Il PLLC | Dermatology | Current | Accepting new patients |
| Vitalskin Medical Group Il PLLC | Dermatology | Current | Accepting new patients |
| Have a Heart Foundation Inc | Current | Accepting new patients |
Locations
114 Manor Ave
Bardstown, KY 40004
Phone (217) 729-7868
1023 Sanibel Way
Ste A
Lagrange, KY 40031
Phone (502) 222-3415
13802 Lake Point Cir
Ste 201
Louisville, KY 40223
Phone (217) 729-7868
310 E Broadway
Ste 100
Louisville, KY 40202
Phone (502) 245-0002
310 E Broadway
Ste 200
Louisville, KY 40202
Phone (502) 585-5249
10619 Meeting St
Unit 106
Prospect, KY 40059
Phone (502) 326-2622
Organizations & group practices 4
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.
-
- Dermatology Physician
- Louisville, KY
- NPI 1235245754
-
- Cardiovascular Disease Physician
- Louisville, KY
- NPI 1881182657
-
- Dermatology Physician
- Mattoon, IL
- NPI 1063030252
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Baptist Health La Grange
- General Acute Care Hospital
- La Grange, KY
- NPI 1306925540
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1116806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439769600000",
"number": "1811990096",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "310 E BROADWAY",
"address_2": "STE 200",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402021745",
"telephone_number": "502-585-5249",
"fax_number": "502-585-5251"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 E BROADWAY",
"address_2": "STE 200",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402021745",
"telephone_number": "502-585-5249",
"fax_number": "502-585-5251"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALDMAN",
"first_name": "MARK",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-05-23",
"last_updated": "2015-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "KY",
"license": "35880",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.