Mark Kwalbrun, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

225726 Issued in NY

Practice address

1571 Washington St
Suite 101
Watertown, NY 13601-9304

Phone

(315) 786-5000

Fax

(315) 786-5001

NPI assigned

Jul 29, 2005

Last updated

Jan 15, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Diagnostic Radiology

Education

State University of New York Downstate Medical Center, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Samaritan Medical CenterGroup PAC ID 8123914876, 157 clinicians

Physician Affiliate Group of New York PCGroup PAC ID 4688098833, 1,222 clinicians

St Lawrence Radiology Assoc PCGroup PAC ID 2264421122, 25 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Canton-Potsdam Hospital Hospital, Potsdam, NY, CCN 330197
• Auburn Community Hospital Hospital, Auburn, NY, CCN 330235
• SLHS Massena, Inc Hospital, Massena, NY, CCN 331322
• Samaritan Medical Center Hospital, Watertown, NY, CCN 330157
• Lincoln Medical & Mental Health Center Hospital, Bronx, NY, CCN 330080

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations (25 of 30)

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

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.

• Samaritan Medical Center

  • General Acute Care Hospital
  • Watertown, NY
  • NPI 1598713745
  Medicare reassignment Care Compare group NPD
• St Lawrence Radiology Assoc PC

  • Diagnostic Radiology Physician
  • Potsdam, NY
  • NPI 1154380863
  Medicare reassignment Care Compare group NPD
• Physician Affiliate Group of New York PC

  • Registered Dietitian
  • New York, NY
  • NPI 1013375526
  Medicare reassignment Care Compare group
• Coney Island Medical Practice Plan, P.C.

  • General Practice Physician
  • Brooklyn, NY
  • NPI 1386951762
  Medicare reassignment NPD
• Downtown Bronx Medical Associates PC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Bronx, NY
  • NPI 1689618407
  Medicare reassignment NPD
• Harlem Medical Associates PC

  • General Practice Physician
  • New York, NY
  • NPI 1487957692
  Medicare reassignment NPD
• Metropolitan Medical Practice Plan PC

  • General Practice Physician
  • New York, NY
  • NPI 1306138383
  Medicare reassignment NPD
• Olean Radiology, PC

  • Diagnostic Radiology Physician
  • Olean, NY
  • NPI 1700829850
  Medicare reassignment NPD
• Seaway Radiology PC

  • Diagnostic Radiology Physician
  • Alexandria Bay, NY
  • NPI 1124012018
  Medicare reassignment NPD
• Upstate Radiology, PC

  • Specialist
  • Watertown, NY
  • NPI 1508241878
  Medicare reassignment NPD
• Ali M Gharagozloo MD PC

  dba Diagnostic & Interventional Radiology, PC

  • Diagnostic Radiology Physician
  • Ogdensburg, NY
  • NPI 1831182633
  Medicare reassignment
• Samaritan Medical Center

  • Rehabilitation Hospital Unit
  • Watertown, NY
  • NPI 1093722068
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Auburn Community Hospital

  • General Acute Care Hospital
  • Auburn, NY
  • NPI 1093712911
  Care Compare affiliation
• Canton-Potsdam Hospital

  • General Acute Care Hospital
  • Potsdam, NY
  • NPI 1568548782
  Care Compare affiliation
• Massena Hospital Inc

  • Critical Access Hospital
  • Massena, NY
  • NPI 1972604460
  Care Compare affiliation
• New York City Health and Hospitals Corporation

  dba Lincoln Medical And Mental Health Center

  • General Acute Care Hospital
  • Bronx, NY
  • NPI 1427063270
  Care Compare affiliation
• Samaritan Medical Center

  • General Acute Care Hospital
  • Watertown, NY
  • NPI 1598713745
  Care Compare affiliation

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

{
    "created_epoch": "1122595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389744000000",
    "number": "1811997042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1571 WASHINGTON ST",
            "address_2": "SUITE 101",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136019304",
            "telephone_number": "315-786-5046",
            "fax_number": "315-786-5043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1571 WASHINGTON ST",
            "address_2": "SUITE 101",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136019304",
            "telephone_number": "315-786-5000",
            "fax_number": "315-786-5001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWALBRUN",
        "first_name": "MARK",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-29",
        "last_updated": "2014-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "225726",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin J Kriesel, MD
• Jack Kriesick, R.PH.
• Krista Krull-Goss
• Livia Margaret Kubica, LMSW
• Courtney Kulzer, LMSW
• Austen Labarge
• Carrie Anne Labarge, LCSW
• Martha Shirley Labarr, PMHNP
• Elise Labatore
• Jacquelyn Suzanne Laclair, LPN

• Diagnostic Radiology Physician in Watertown, NY
• Providers in Watertown, NY by specialty
• Diagnostic Radiology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2014; 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.

Verify at the official NPI Registry.