Individual provider Active NPI

Mark Stevens Clee, M.D.

  • Pediatrics Physician
  • Cincinnati, OH
National Provider Identifier
1972946648
Registry record updated Jul 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
R0847 Issued in TX
Practice address
3333 Burnet Ave
Cincinnati, OH 45229-3026
Phone
(513) 636-4315
Fax
(513) 636-7905
NPI assigned
Apr 12, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X R0847 TX
Student in an Organized Health Care Education/Training Program 390200000X
Pediatrics Physician 208000000X R0847 TX Primary

Addresses

Primary practice location

3333 Burnet Ave
Cincinnati, OH 45229-3026

Mailing address

PO Box 5576
Midland, TX 79704-5576
Phone (432) 620-8874

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20200518001119 TX Practitioner - Pediatric Medicine 5890126379 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R0847TXMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cook Children'S Physician Network Pediatrics CurrentSince Mar 1, 2020 Accepting new patients
Midland Community Healthcare Services CurrentSince Jul 18, 2022 Accepting new patients
Cook Children'S Physician Network Pediatrics CurrentSince Mar 1, 2020 Accepting new patients
Midland Community Healthcare Services CurrentSince Jul 18, 2022 Accepting new patients
TCH Pediatric Associates, Inc Pediatrics Past Accepting new patients

Locations

1500 W Rosedale St
Fort Worth, TX 76104
Phone (682) 885-3426

801 7th Ave
Ft Worth, TX 76104
Phone (682) 885-4054

4214 Andrews Hwy
Ste 310
Midland, TX 79703
Phone (432) 697-4747

2500 Delano Ave
Midland, TX 79701
Phone (432) 697-4747

Interoperability endpoints

  • Direct secure messaging: mclee217865@prddirect.texaschildrens.org

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1365724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657670400000",
    "number": "1972946648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5576",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797045576",
            "telephone_number": "432-620-8874",
            "fax_number": "432-669-3815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 BURNET AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452293026",
            "telephone_number": "513-636-4315",
            "fax_number": "513-636-7905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEE",
        "first_name": "MARK",
        "middle_name": "STEVENS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-12",
        "last_updated": "2022-07-13",
        "certification_date": "2022-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "TX",
            "license": "R0847",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "R0847",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

Verify at the official NPI Registry.