Mark Kwalbrun, MD

Key facts

NPI

1811997042

Entity type

Individual (NPI type 1)

Primary specialty

Diagnostic Radiology Physician 2085R0202X

License

225726 (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

Sex

Male

Sole proprietor

Yes

Organizations & group practices 17

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.

• Samaritan Medical Center General Acute Care Hospital · Watertown, NY · NPI 1598713745
  Medicare reassignment Care Compare group NPD NY
• St Lawrence Radiology Assoc PC Diagnostic Radiology Physician · Potsdam, NY · NPI 1154380863
  Medicare reassignment Care Compare group NPD DIAGNOSTIC RADIOLOGY · NY
• Physician Affiliate Group of New York PC Registered Dietitian · New York, NY · NPI 1013375526
  Medicare reassignment Care Compare group NY
• Coney Island Medical Practice Plan, P.C. General Practice Physician · Brooklyn, NY · NPI 1386951762
  Medicare reassignment NPD NY
• Downtown Bronx Medical Associates PC Emergency Medical Services (Emergency Medicine) Physician · Bronx, NY · NPI 1689618407
  Medicare reassignment NPD NY
• Harlem Medical Associates PC General Practice Physician · New York, NY · NPI 1487957692
  Medicare reassignment NPD NY
• Metropolitan Medical Practice Plan PC General Practice Physician · New York, NY · NPI 1306138383
  Medicare reassignment NPD NY
• Olean Radiology, PC Diagnostic Radiology Physician · Olean, NY · NPI 1700829850
  Medicare reassignment NPD DIAGNOSTIC RADIOLOGY · NY
• Seaway Radiology PC Diagnostic Radiology Physician · Alexandria Bay, NY · NPI 1124012018
  Medicare reassignment NPD DIAGNOSTIC RADIOLOGY · NY
• Upstate Radiology, PC Specialist · Watertown, NY · NPI 1508241878
  Medicare reassignment NPD NY
• Samaritan Medical Center Rehabilitation Hospital Unit · Watertown, NY · NPI 1093722068
  Care Compare group NPD
• Ali M Gharagozloo MD PC Diagnostic Radiology Physician · Ogdensburg, NY · NPI 1831182633
  Medicare reassignment NY
• Samaritan Medical Center Community/Retail Pharmacy · Watertown, NY · NPI 1447051305
  Care Compare group
• Icahn School of Medicine at Mount Sinai Specialty Pharmacy · New York, NY · NPI 1629410816
  NPD (past)
• Imaging Subspecialist of New York Diagnostic Neuroimaging (Radiology) Physician · Middletown, NY · NPI 1124655352
  NPD (past)
• Lincon Medical and Mental Center Critical Access Hospital · Bronx, NY · NPI 1902979651
  NPD (past) DIAGNOSTIC RADIOLOGY
• Mount Sinai School of Medicine Specialist · New York, NY · NPI 1568480523
  NPD (past)

Hospital & facility affiliations 5

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 Hospital
• Canton-Potsdam Hospital General Acute Care Hospital · Potsdam, NY · NPI 1568548782
  Care Compare affiliation Hospital
• Massena Hospital Inc Critical Access Hospital · Massena, NY · NPI 1972604460
  Care Compare affiliation Hospital
• New York City Health and Hospitals Corporation General Acute Care Hospital · Bronx, NY · NPI 1427063270
  Care Compare affiliation Hospital
• Samaritan Medical Center General Acute Care Hospital · Watertown, NY · NPI 1598713745
  Care Compare affiliation Hospital

Medicare Care Compare profile

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 Center (157 clinicians)
Physician Affiliate Group of New York PC (1,222 clinicians)
St Lawrence Radiology Assoc PC (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 participation

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

State licenses

Practice roles (14 of 18)

Locations (25 of 30)

Networks

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

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 15, 2014.

{
    "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02461787",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Watertown, NY · Diagnostic Radiology Physician in New York