Individual provider Active NPI

Mark A Waldman, MD

  • Dermatology Physician
  • Louisville, KY
National Provider Identifier
1811990096
Registry record updated Aug 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
35880 Issued in KY
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, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101228000723 KY Practitioner - Dermatology 4385832880 Reassigns benefits to 2 organizations

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
Vitalskin Medical Group Il PLLCGroup PAC ID 5991116261, 56 clinicians
Dr William M Parsley MD PSCGroup PAC ID 1951378850, 6 clinicians

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 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision11
Removal of skin lesions1319
Removal or shaving of skin growth21
Skin biopsy328

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35880KYMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Vitalskin Medical Group Il PLLC Dermatology CurrentSince Nov 21, 2023 Accepting new patients
Vitalskin Medical Group Il PLLC Dermatology CurrentSince Nov 21, 2023 Accepting new patients
Have a Heart Foundation Inc CurrentSince Jan 1, 2019 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.

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": "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

Verify at the official NPI Registry.