NPIMap

Individual provider Active NPI

Mark Alan Robertson, MD

  • Otolaryngology Physician
  • Bartlesville, OK
National Provider Identifier
1962457697
Registry record updated Mar 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
20308 Issued in OK
Practice address
205 SE Howard Ave
Bartlesville, OK 74006-2204
Phone
(918) 333-0474
Fax
(918) 333-5125
NPI assigned
May 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 20308 OK Primary

Addresses

Primary practice location

205 SE Howard Ave
Bartlesville, OK 74006-2204

Mailing address

205 SE Howard Ave
Bartlesville, OK 74006-2204
Phone (918) 333-0474

Other identifiers 2

IdentifierTypeStateIssuer
P00605374OtherOKRAILROAD MEDICARE
100130950AMedicaidOK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040930000415 OK Practitioner - Otolaryngology 6305815952 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of Oklahoma College of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. John Physicians, Inc.Group PAC ID 2567366495, 262 clinicians

Practice addresses (Care Compare)

1705 E 19TH St
Tulsa, OK 74104-5410

3550 E Frank Phillips Blvd
Bartlesville, OK 74006-2411
Phone (918) 331-2294

Hospital & facility affiliations

  • Ascension St John Jane Phillips Hospital, Bartlesville, OK, CCN 370018
  • Coffeyville Regional Medical Center, Inc Hospital, Coffeyville, KS, CCN 171387
  • Good Samaritan Regional Medical Center Hospital, Corvallis, OR, CCN 380014
  • Samaritan Albany General Hospital Hospital, Albany, OR, CCN 380022

Merit-based Incentive Payment System (MIPS)

Final score
93.65 of 100Reported as group
Quality
86.8
Promoting interoperability
100
Improvement activities
40
Cost
86.36

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20308OKMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. John Physicians, Inc. Current Accepting new patients
St. John Physicians, Inc CurrentSince Jan 1, 2020 Accepting new patients
Jane Phillips Memorial Medical Center, Inc. Past Accepting new patients

Locations

1400 W 4th St
Coffeyville, KS 67337
Phone (620) 251-1200

3500 E Frank Phillips Blvd
Bartlesville, OK 74006
Phone (918) 331-1555

205 SE Howard Ave
Bartlesville, OK 74006
Phone (918) 333-0474

1705 E 19th St
Ste 302
Tulsa, OK 74104
Phone (918) 748-7585

1705 E 19th St
Ste 304
Tulsa, OK 74104
Phone (918) 748-7660

Interoperability endpoints

  • Direct secure messaging: mark.robertson@direct.stjohnhealthsystem.com

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 and National Provider Directory roles.

Hospital & facility affiliations 41

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

View all 41

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489708800000",
    "number": "1962457697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 SE HOWARD AVE",
            "city": "BARTLESVILLE",
            "state": "OK",
            "postal_code": "740062204",
            "telephone_number": "918-333-0474",
            "fax_number": "918-333-5125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 SE HOWARD AVE",
            "city": "BARTLESVILLE",
            "state": "OK",
            "postal_code": "740062204",
            "telephone_number": "918-333-0474",
            "fax_number": "918-333-5125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "MARK",
        "middle_name": "ALAN",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2017-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "OK",
            "license": "20308",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00605374",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100130950A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bartlesville, OK

Sources for this page

Verify at the official NPI Registry.