NPIMap

Individual provider Active NPI

Myra Josephine Mark, M.D.

  • Family Medicine Physician
  • Akron, OH
National Provider Identifier
1851408959
Registry record updated Dec 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35-075527 Issued in OH
Practice address
3535 Granger Rd
Akron, OH 44333-1538
Phone
(330) 666-3400
NPI assigned
Aug 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35-075527 OH Primary

Addresses

Primary practice location

3535 Granger Rd
Akron, OH 44333-1538

Mailing address

1001 Lakeside Ave E
#1200
Cleveland, OH 44114-1158

Other identifiers 1

IdentifierTypeStateIssuer
2189448MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address myramark@uhps.allscriptsdirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050722000113 OH Practitioner - Family Practice 6709813694 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Northeastern Ohio University College of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

11100 Euclid Ave
Cleveland, OH 44106-1716

158 W Main Rd
Conneaut, OH 44030-2039

5133 Ridge Rd
Wadsworth, OH 44281-8078

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35-075527OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Primary Care Practices Inc Family Medicine CurrentSince Feb 1, 2016 Accepting new patients
University Primary Care Practices Inc Current Accepting new patients
University Primary Care Practices Inc CurrentSince Feb 1, 2016 Accepting new patients
The Metrohealth System Current Accepting new patients

Locations

158 W Main Rd
Ste 203
Conneaut, OH 44030
Phone (440) 285-2960

Interoperability endpoints

  • Direct secure messaging: mmark114091@direct.metrohealth.org
  • Direct secure messaging: mmark36833@ehrdirect.uhhospitals.org

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 and National Provider Directory roles.

Hospital & facility affiliations 10

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": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608163200000",
    "number": "1851408959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 LAKESIDE AVE E",
            "address_2": "#1200",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441141158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 GRANGER RD",
            "city": "AKRON",
            "state": "OH",
            "postal_code": "443331538",
            "telephone_number": "330-666-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARK",
        "first_name": "MYRA",
        "middle_name": "JOSEPHINE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-24",
        "last_updated": "2020-12-17",
        "certification_date": "2020-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35-075527",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2189448",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "myramark@uhps.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "3535 Granger Rd",
            "city": "Akron",
            "state": "OH",
            "country_code": "US",
            "postal_code": "443331538",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Akron, OH

Sources for this page

Verify at the official NPI Registry.