Active NPI
Mark C Duster, MD
- Pediatric Cardiology Physician
- Colorado Springs, CO
National Provider Identifier
1902903198
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Cardiology Physician
- License
- 21521
- Practice address
- 1400 E Boulder St
Memorial Childrens Hospital
Colorado Springs, CO 80909-5533 - Phone
- (719) 365-9543
- Fax
- (719) 365-5530
- NPI assigned
- Sep 20, 2006
- Reactivated
- Sep 5, 2018
- Last updated
- Sep 5, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Cardiology Physician | 2080P0202X | 21521 | CO | Primary |
Addresses
Primary practice location
1400 E Boulder St
Memorial Childrens Hospital
Colorado Springs, CO 80909-5533
Mailing address
1400 E Boulder St
Memorial Childrens Hospital
Colorado Springs, CO 80909-5533
Phone (719) 365-9543
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01215219 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21521 | CO | MD | Pediatric Cardiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Uch-MHS | Past | Accepting new patients | |
| Memorial Health System | Past | Accepting new patients | |
| Pediatric Cardiology Associates | Pediatric Cardiology | Past | Accepting new patients |
Organizations & group practices 3
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.
-
dba Memorial Hospital Phys Group
- General Acute Care Hospital
- Colorado Springs, CO
- NPI 1568668754
-
- Pediatric Cardiology Physician
- Colorado Springs, CO
- NPI 1982794798
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536105600000",
"number": "1902903198",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 E BOULDER ST",
"address_2": "MEMORIAL CHILDRENS HOSPITAL",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809095533",
"telephone_number": "719-365-9543",
"fax_number": "719-365-5530"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 E BOULDER ST",
"address_2": "MEMORIAL CHILDRENS HOSPITAL",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809095533",
"telephone_number": "719-365-9543",
"fax_number": "719-365-5530"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUSTER",
"first_name": "MARK",
"middle_name": "C",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2018-09-05",
"deactivation_date": "2017-05-15",
"reactivation_date": "2018-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0202X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Cardiology",
"state": "CO",
"license": "21521",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01215219",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.