DR. MARK J. WALTERSKIRCHEN (NPI# 1083637524) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083637524 |
| Entity Type | Individual |
| Full Name | DR. MARK J. WALTERSKIRCHEN |
| Credential | M.D. |
| Practice Address |
1965 S Fremont Ave Suite 370 Springfield MO 65804-2201 |
| Mailing Address |
Po Box 2580 Springfield MO 65801-2580 |
| Practice Telephone | 4178200300 |
| Practice Fax Number | 4178829645 |
| Mailing Telephone | 4178294620 |
| Mailing Fax Number | 4178294316 |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2012-09-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | MD00048487 | WA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | NPI # | 1083637524 | 01 |
| MO | RR MEDICARE PROV. # | 340017773 | 01 |
| MO | 204964605 | 05 |
| Street Address |
1965 S FREMONT AVE SUITE 370 |
| City | SPRINGFIELD |
| State | MO |
| Zip Code | 65804-2201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205834074 | Tyrun Keith Richardson | Urology | 1965 S Fremont Ave, Ste 370, Springfield, MO 65804-2201 | 2005-07-14 |
| 1366934069 | Kelsi Brooke Yates | Registered Nurse | 1965 S Fremont Ave, Springfield, MO 65804 | 2018-05-30 |
| 1629515440 | Ashley Jenkins | Physician Assistant | 1965 S Fremont Ave, Ste 370, Springfield, MO 65804-2201 | 2017-01-31 |
| 1538602719 | Brianna Sikes | Registered Nurse | 1965 S Fremont Ave, Suite 230, Springfield, MO 65804-2201 | 2016-11-21 |
| 1497105779 | Krista Norrick | Occupational Therapist | 1965 S Fremont Ave, Ste 230, Springfield, MO 65804-2201 | 2016-06-16 |
| 1952750846 | Lori Pumphrey | Occupational Therapist | 1965 S Fremont Ave, Ste 230, Springfield, MO 65804-2201 | 2016-06-10 |
| 1306205414 | Jason Hall | Physician Assistant | 1965 S Fremont Ave, Ste 230, Springfield, MO 65804-2201 | 2016-02-17 |
| 1811382500 | Megan A. Martin | Nurse Practitioner | 1965 S Fremont Ave, Suite 300, Springfield, MO 65804-2201 | 2015-03-31 |
| 1588055578 | Inna L. Bates | Nurse Practitioner | 1965 S Fremont Ave, Suite 350, Springfield, MO 65804-2201 | 2015-02-11 |
| 1770990228 | Karina Marie Guffey | Nurse Practitioner | 1965 S Fremont Ave, Springfield, MO 65804-2201 | 2014-07-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790393049 | Kathy Forson | Nurse Practitioner | 1235 E. Cherokee St., Springfield, MO 65804 | 2020-07-22 |
| 1306498779 | Anne B Summers, LLC | Social Worker | 1310 E. Kingsley St., Ste C, Springfield, MO 65804 | 2019-07-15 |
| 1790241800 | Margaret Mary Hart | Social Worker | 1845 S Rogers Ave, Springfield, MO 65804 | 2019-02-13 |
| 1598254666 | Casey Carr | Optometrist | 1229 E Seminole St Ste 110, Springfield, MO 65804 | 2018-05-04 |
| 1124520697 | Shelby D White | Behavioral Analyst | 1300 E. Bradford Parkway, Springfield, MO 65804 | 2018-03-01 |
| 1316448343 | Karl Lynham | Massage Therapist | 1200 E Woodhurst Dr R300, Springfield, MO 65804 | 2018-02-25 |
| 1699273763 | Leah Wilson | Counselor | 1322 E Woodgate, Springfield, MO 65804 | 2018-01-24 |
| 1295242626 | Matthew Crisp | Physical Therapist | 3252 E Independence St, Springfield, MO 65804 | 2018-01-08 |
| 1518491042 | Crystal Spangler | Dietitian, Registered | 1965 S Fremont Ave Ste 220, Springfield, MO 65804 | 2017-04-11 |
| 1588012033 | Jeffrey Williams | Pharmacist | 1235 E. Cherokee, Springfield, MO 65804 | 2016-05-25 |
| Find all providers in zip 65804 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649796376 | Urology Associates PC | Urology | 502 Northcrest Dr, Springfield, TN 37172-4066 | 2017-08-15 |
| 1912436015 | Robert Ara Petrossian | Urology | 301 N 8th St # 4b143c, Springfield, IL 62701-1041 | 2017-06-12 |
| 1932463940 | Brandi Dawn Miller | Urology | 1965 S Fremont Ave Ste 370, Springfield, MO 65804-2284 | 2012-06-25 |
| 1699049395 | Harry L. Ellis | Urology | 5034 S Glenhaven Ave, Springfield, MO 65804-7804 | 2012-02-28 |
| 1427121714 | David R Kelley | Urology | 100 Wason Anenue, Suite 120, Springfield, MA 01107-1119 | 2006-11-16 |
| 1942373311 | Charles D Parsons | Urology | 202 S Belmont Ave, Springfield, OH 45505-1224 | 2006-11-15 |
| 1447321781 | Pbm Urology Ltd | Urology | 1215 S 4th St, Springfield, IL 62703-2259 | 2006-11-10 |
| 1013019439 | Alexander M Berry | Urology | 100 Wason Ave, Suite 240, Holyoke Medicacal Center - Urology, Springfield, MA 01107 | 2006-09-05 |
| 1972615748 | Thomas E. Baron | Urology | 800 N. 1st Street, Springfield, IL 62702 | 2006-08-31 |
| 1265405914 | Eric Espinosa | Urology | 1164 E Home Rd, Suite J, Springfield, OH 45503-2726 | 2006-02-10 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 65804 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.