Individual provider Active NPI

Jonathan Russell Mark, M.D.

  • Otolaryngology Physician
  • Norfolk, VA
National Provider Identifier
1902048952
Registry record updated Feb 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
35.124086 Issued in OH
Practice address
600 Gresham Dr Ste 1100
Norfolk, VA 23507-1904
Phone
(757) 388-6200
NPI assigned
Apr 6, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 0116021508 VA
Otolaryngology Physician 207Y00000X 35.124086 OH Primary

Addresses

Primary practice location

600 Gresham Dr Ste 1100
Norfolk, VA 23507-1904

Mailing address

600 Gresham Dr Ste 1100
Norfolk, VA 23507-1904

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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

Enrollment IDStateProvider typePAC IDDetails
I20180502002555 VA Practitioner - Otolaryngology 4486876075 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Eastern Virginia Medical School, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

600 Gresham Dr
Norfolk, VA 23507-1904
Phone (757) 388-6200

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux33
Melanoma (skin cancer) excision35
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.124086OHMDOtolaryngology Physician
0116021508VAMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Childrens Specialty Group PLLC CurrentSince Sep 1, 2025 Accepting new patients
Evms Academic Physicians and Surgeons Health Services Foundation Otolaryngology CurrentSince May 21, 2018 Accepting new patients

Locations

600 Gresham Dr
Norfolk, VA 23507
Phone (757) 473-0055

601 Childrens Ln
Norfolk, VA 23507
Phone (757) 668-7272

6261 E Virginia Beach Blvd
Ste 200
Norfolk, VA 23502
Phone (757) 625-4455

600 Gresham Dr
Ste 1100
Norfolk, VA 23507
Phone (757) 388-6200

2075 Glenn Mitchell Dr
Ste 310
Virginia Beach, VA 23456
Phone (757) 689-8500

Organizations & group practices 2

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 6

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": "1238976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645056000000",
    "number": "1902048952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 GRESHAM DR STE 1100",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 GRESHAM DR STE 1100",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071904",
            "telephone_number": "757-388-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARK",
        "first_name": "JONATHAN",
        "middle_name": "RUSSELL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-06",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "VA",
            "license": "0116021508",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "OH",
            "license": "35.124086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norfolk, VA

Sources for this page

Verify at the official NPI Registry.