NPIMap

Individual provider Active NPI

Mark W Tuccillo, DO

  • Sports Medicine (Family Medicine) Physician
  • Petersburg, AK
National Provider Identifier
1942237441
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
AA2935 Issued in AK
Practice address
103 Fram Street
Petersburg, AK 99833-0589
Phone
(907) 772-4299
NPI assigned
Jun 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X AA2935 AK Primary

Addresses

Primary practice location

103 Fram Street
Petersburg, AK 99833-0589

Mailing address

PO Box 2120
Petersburg, AK 99833-2120
Phone (907) 772-3975

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, AK2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20081017000457 TX Practitioner - Family Practice 0648338723 Reassigns benefits to 1 organization
I20090612000311 AK Practitioner - Family PracticePractitioner - Sports Medicine 0648338723 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
Rowan University School of Osteopathic Medicine, 1989
Medicare assignment
May accept Medicare assignment
Group practices
The Petersburg Medical CenterGroup PAC ID 5395730626, 7 clinicians
Southeast Alaska Regional Health ConsortiumGroup PAC ID 1456265362, 373 clinicians

Practice addresses (Care Compare)

103 Fram St
Petersburg, AK 99833
Phone (907) 772-4291

103 Fram St
PO Box 589
Petersburg, AK 99833-0589

1204 Seward Ave
Searhc 1204 Behavioral Health Sitka
Sitka, AK 99835-7359
Phone (907) 966-8611

1206 Seward Ave
Searhc 1206 Behavioral Health Sitka
Sitka, AK 99835-7359
Phone (907) 966-8611

1209 Seward Ave
Searhc 1209 Behavioral
Sitka, AK 99835-7359
Phone (907) 966-8611

222 Tongass Dr
Sitka, AK 99835-9416
Phone (907) 966-2411

227 Tongass Dr
Sitka, AK 99835-9416
Phone (907) 966-2411

28 Dock St
Searhc Gustavus Clinic
Gustavus, AK 99826-0399
Phone (907) 697-3008

PO Box
Suite 589
Petersburg, AK 99833

PO Box
Suite 589
Petersburg, AK 99833-0589

Hospital & facility affiliations

  • Southeast Alaska Regional Health Consortium Hospital, Sitka, AK, CCN 021314
  • Petersburg Medical Center Hospital, Petersburg, AK, CCN 021304

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AA2935AKMDSports Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Alaska Regional Health Consortium CurrentSince Nov 5, 2017 Accepting new patients
Southeast Alaska Regional Health Consortium Current Accepting new patients
The Petersburg Medical Center CurrentSince Jun 1, 1989 Accepting new patients
The Petersburg Medical Center CurrentSince Jun 1, 1989 Accepting new patients
Southeast Alaska Regional Health Consortium CurrentSince Nov 5, 2017 Accepting new patients
South East Alaska Regional Health Consortium Past Accepting new patients
The Petersburg Medical Center Past Accepting new patients

Locations

3100 Channel Dr
Ste 300
Juneau, AK 99801
Phone (907) 463-4000

222 Tongass Dr
Sitka, AK 99835
Phone (907) 966-8423

Organizations & group practices 16

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.

View all 16

Hospital & facility affiliations 36

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

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1942237441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2120",
            "city": "PETERSBURG",
            "state": "AK",
            "postal_code": "998332120",
            "telephone_number": "907-772-3975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 FRAM STREET",
            "city": "PETERSBURG",
            "state": "AK",
            "postal_code": "998330589",
            "telephone_number": "907-772-4299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCCILLO",
        "first_name": "MARK",
        "middle_name": "W",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "AK",
            "license": "AA2935",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petersburg, AK

Sources for this page

Verify at the official NPI Registry.