Mark Anthony Bergonia Ison, CRNP- PMH

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R181848 Issued in MD

Practice address

1501 Sulgrave Ave Ste 200
Baltimore, MD 21209-3650

Phone

(443) 708-5856

NPI assigned

Mar 9, 2019

Last updated

Mar 9, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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 MD

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, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Wellness Legacy LLCGroup PAC ID 1052743457, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wellness Legacy LLC

  • Nurse Practitioner
  • Bel Air, MD
  • NPI 1134777576

  Psychiatric/Mental Health

  Medicare reassignment Care Compare group NPD
• Wellness Legacy LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Towson, MD
  • NPI 1992433916
  NPD Authorized official
• Wellness Legacy LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Bel Air, MD
  • NPI 1265039549
  NPD (past)

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

{
    "created_epoch": "1552089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552089600000",
    "number": "1881152783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 SULGRAVE AVE STE 200",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212093650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 SULGRAVE AVE STE 200",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212093650",
            "telephone_number": "443-708-5856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISON",
        "first_name": "MARK ANTHONY",
        "middle_name": "BERGONIA",
        "name_prefix": "Mr.",
        "credential": "CRNP- PMH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-09",
        "last_updated": "2019-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R181848",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abdellatif Salah Ismail, M.D.
• Ammar Hashem Ismail, MBBS
• Fatima Yousif Ismail, MBBS
• Adedamola Isola
• Lera Salvatierra Ison, CRNP- F
• Benjamin Simon Preston Israel, M.D.
• Cornelia Iolanda Israel, LCPC
• Daniel Shlomo Israel, MD
• Desiree Luerene Israel, LCSW-C
• Jennifer Israel, RN

• Psychiatric/Mental Health Nurse Practitioner in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2019; 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.