Mark A Dittenbir, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

4301048692 Issued in MI

Practice address

601 John St Ste M283A
Kalamazoo, MI 49007-5341

Phone

(269) 349-7696

Fax

(269) 488-8313

NPI assigned

Jun 6, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in MI, VT, MT, ND, AZ5 enrollments

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 5

Specialty

General Surgery

Education

Michigan State University College of Human Medicine, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lakeland Medical PracticesGroup PAC ID 1658427042, 286 clinicians

St Alexius Medical CenterGroup PAC ID 8426960865, 239 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• CHI St Alexius Health Hospital, Bismarck, ND, CCN 350002
• Lakeland Hospital, St Joseph Hospital, St Joseph, MI, CCN 230021
• Summit Healthcare Regional Medical Center Hospital, Show Low, AZ, CCN 030062

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mdittenbir1269173@epic00.corewelldirect.org

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.

• Lakeland Medical Practices

  • Internal Medicine Physician
  • Saint Joseph, MI
  • NPI 1538397120
  Medicare reassignment Care Compare group NPD
• St. Alexius Medical Center

  • Specialist
  • Bismarck, ND
  • NPI 1205868429
  Medicare reassignment Care Compare group NPD
• Bronson Methodist Hospital

  • Hospitalist Physician
  • Kalamazoo, MI
  • NPI 1417961137
  Medicare reassignment NPD
• Acute Care Surgery Medical Group, Inc.

  • Surgery Physician
  • Sacramento, CA
  • NPI 1700069549

  MI

  Medicare reassignment NPD
• Holy Rosary Healthcare

  • Clinic/Center
  • Miles City, MT
  • NPI 1225201825
  Medicare reassignment NPD
• SCL Health Medical Group-Butte LLC

  • Family Medicine Physician
  • Butte, MT
  • NPI 1477869600
  Medicare reassignment NPD
• Springfield Hospital

  • Critical Access Hospital Clinic/Center
  • Springfield, VT
  • NPI 1033225875
  Medicare reassignment NPD
• Summit Healthcare Medical Associates

  • Family Medicine Physician
  • Show Low, AZ
  • NPI 1467878108

  Surgery

  Medicare reassignment NPD
• Lakeland Medical Practices

  • Internal Medicine Physician
  • Bridgman, MI
  • NPI 1568232247
  NPD
• Holy Rosary Healthcare

  • Community Based Hospice Care Agency
  • Miles City, MT
  • NPI 1396969812
  NPD
• SCL Health Medical Group-Butte LLC

  • Rural Health Clinic/Center
  • Boulder, MT
  • NPI 1861031122
  NPD
• Springfield Hospital .Inc

  • Critical Access Hospital
  • Springfield, VT
  • NPI 1982743969
  NPD

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

• Lakeland Hospitals at Niles and St Joseph, Inc

  • General Acute Care Hospital
  • Saint Joseph, MI
  • NPI 1134220031
  Care Compare affiliation
• St. Alexius Medical Center

  • General Acute Care Hospital
  • Bismarck, ND
  • NPI 1306832654
  Care Compare affiliation
• Summit Healthcare Association

  • Oncology Clinic/Center
  • Show Low, AZ
  • NPI 1083736128

  Hospital

  Care Compare affiliation
• Summit Healthcare Association

  • Rural Acute Care Hospital
  • Show Low, AZ
  • NPI 1144209271
  Care Compare affiliation
• Summit Healthcare Medical Associates

  • Rural Health Clinic/Center
  • Overgaard, AZ
  • NPI 1770700767

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525132800000",
    "number": "1942249727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 JOHN ST",
            "address_2": "SUITE M283A",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490075341",
            "telephone_number": "269-349-7696",
            "fax_number": "269-488-8313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 JOHN ST STE M283A",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490075341",
            "telephone_number": "269-349-7696",
            "fax_number": "269-488-8313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DITTENBIR",
        "first_name": "MARK",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2018-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MI",
            "license": "4301048692",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301048692",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GRP PIN",
            "identifier": "020C91020",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS IND PIN",
            "identifier": "3403901640",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PIN",
            "identifier": "5515041",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT LAKES HLTH PLN",
            "identifier": "116658",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM - BRONSON",
            "identifier": "1417961137",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1942249727",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3218986-10",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Madeleine Kay Dirette, BS, QMHP
• Richard A Dirrenberger, M.D.
• Disability Network Southwest Michigan
• Chaminda Rasika Dissanayake, MD
• Kimberly Kay Ditto, MA, LLP
• Diversified Psychological Services LLC
• Chason Dixon-McKenzie
• Paul Dixon
• DJMM Inc

• Surgery Physician in Kalamazoo, MI
• Providers in Kalamazoo, MI by specialty
• Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2018; 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.