Mark Duwayne Deis

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5663497-4405 Issued in UT

Practice address

6154 S 2175 E
Ogden, UT 84403-5354

Phone

(801) 726-3738

NPI assigned

Oct 27, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kameo Health Wellness and Beauty PLLCGroup PAC ID 3476996323, 2 clinicians

Amazing Medical Associates IncGroup PAC ID 5991606329, 24 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006
• Intermountain Health McKay-Dee Hospital Hospital, Ogden, UT, CCN 460004
• Intermountain Health Layton Hospital Hospital, Layton, UT, CCN 460061

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Kameo Health Wellness and Beauty PLLC

  • Family Nurse Practitioner
  • West Haven, UT
  • NPI 1043092927

  Family Medicine

  Medicare reassignment Care Compare group NPD Authorized official
• Amazing Medical Associates, Inc

  • Multi-Specialty Clinic/Center
  • Murray, UT
  • NPI 1487836532

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Brandy Marie Family & Aesthetic Care LLC

  • Family Nurse Practitioner
  • Clinton, UT
  • NPI 1275134132
  Medicare reassignment NPD
• Wasatch Post-Acute Services

  • Physical Medicine & Rehabilitation Physician
  • Ogden, UT
  • NPI 1144922477
  Medicare reassignment NPD

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

• Ihc Health Services Inc

  • General Acute Care Hospital
  • Ogden, UT
  • NPI 1194749580
  Care Compare affiliation
• Ihc Health Services, Inc.

  • General Acute Care Hospital
  • Layton, UT
  • NPI 1417460205
  Care Compare affiliation
• St Lukes Regional Medical Center

  • Ambulance
  • Boise, ID
  • NPI 1518115195

  Hospital

  Care Compare affiliation
• St Lukes Regional Medical Center

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1770586794
  Care Compare affiliation

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

{
    "created_epoch": "1635292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666051200000",
    "number": "1821752676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6154 S 2175 E",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844035354",
            "telephone_number": "801-726-3738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6154 S 2175 E",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844035354",
            "telephone_number": "801-726-3738"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1448 N 2000 W Ste 3",
            "address_purpose": "LOCATION",
            "city": "Clinton",
            "state": "UT",
            "postal_code": "840158388",
            "country_code": "US",
            "telephone_number": "801-528-4033",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEIS",
        "first_name": "MARK",
        "middle_name": "DUWAYNE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-10-27",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "UT",
            "license": "56634973102",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "5663497-4405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMERCIAL INSURANCE",
            "identifier": "1275134132",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1275134132",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Derek Debruin
• Braxton Defriez, PHARMD
• Justin Richard Degooyer, APRN
• Cassandra Lenore Degroot
• Benjamin Dehaan, OT
• Kyra Dawn Delcambre, MCMHC, LPC
• Estrella Delgado Ortega
• Janice L. Delgado
• John-Michael Keoni Dellermann, DC, CCSP, LAT, ATC
• Victoria Dawn Delli Gatti, FNP

• Family Nurse Practitioner in Ogden, UT
• Providers in Ogden, UT by specialty
• Family Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2022; 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.