MARK OLTERMANN (NPI# 1154353357) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154353357 |
| Entity Type | Individual |
| Full Name | MARK OLTERMANN |
| Credential | MD |
| Practice Address |
1500 S Main St Fort Worth TX 76104 |
| Mailing Address |
1617 Hemphill St Attn Credentialing Fort Worth TX 76104-4709 |
| Practice Telephone | 8179213431 |
| Mailing Telephone | 8177023381 |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2018-06-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | G8323 | TX | Allopathic & Osteopathic Physicians |
| N | 207RC0200X |
Internal Medicine Specialization: Critical Care Medicine |
16376 | NV | Allopathic & Osteopathic Physicians |
| Y | 207RC0200X |
Internal Medicine Specialization: Critical Care Medicine |
G8323 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 200003780A | 05 | |
| NM | 59339837 | 05 | |
| TX | 150942401 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1155 Mill St, Reno, NV 895021576 | 7759827878 | 7759824196 |
| Street Address |
1500 S MAIN ST |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76104 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518964634 | Akber M Ashraf | Internal Medicine | 1500 S Main St, Fort Worth, TX 76104-4917 | 2005-07-05 |
| 1518567395 | Jordan Loeffelholz | Pediatrics | 1500 S Main St, Fort Worth, TX 76104-4917 | 2020-10-29 |
| 1891305827 | Sandra Bialose | Nurse Practitioner | 1500 S Main St, Fort Worth, TX 76104-4917 | 2020-08-04 |
| 1467060889 | Melissa Godfrey Wood | Nurse Practitioner | 1500 S Main St, Fort Worth, TX 76104-4917 | 2020-07-22 |
| 1053929901 | Brenton C Hall | Pharmacist | 1500 S Main St, Fort Worth, TX 76104-4941 | 2020-07-16 |
| 1952919144 | Chinyere Lilian Nkwocha | Pharmacist | 1500 S Main St, Fort Worth, TX 76104-4917 | 2020-07-14 |
| 1033727227 | Haley Leverett | Pharmacist | 1500 S Main St, Fort Worth, TX 76104-4917 | 2020-07-14 |
| 1447875760 | Lauren Courtney Thompson | Nurse Practitioner | 1500 S Main St, Fort Worth, TX 76104-4917 | 2020-06-12 |
| 1356965883 | Arjun Kulandaivelu | Student in an Organized Health Care Education/Training Program | 1500 S Main St, Fort Worth, TX 76104-4917 | 2020-06-01 |
| 1831710482 | Oliver Taylor | Family Medicine | 1500 S Main St, Fort Worth, TX 76104-4941 | 2020-05-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669082186 | Cvs Pharmacy, Inc. | Durable Medical Equipment & Medical Supplies | 1115 8th St, Fort Worth, TX 76104 | 2020-08-10 |
| 1992343693 | Iris Giove | Psychologist | John Peter Smith Hospital, 1500 S. Main St., Fort Worth, TX 76104 | 2019-12-13 |
| 1104480656 | Swarnalaxmi Umapathy | Student in an Organized Health Care Education/Training Program | 900 8th Avenue, Fort Worth, TX 76104 | 2019-04-30 |
| 1881189132 | Mega Surgical Assistants LLC | Specialist/Technologist, Other | 1301pennsylvania, Fort Worth, TX 76104 | 2018-06-28 |
| 1356848899 | Tricia Kelly | Nurse Practitioner | 1325 Pennsylvania Avenue Suite 560, Fort Worth, TX 76104 | 2018-04-11 |
| 1952820979 | Modern Vein Clinic | Internal Medicine | 757 8th Avenue, Suite A, Forth Worth, TX 76104 | 2017-09-11 |
| 1790207165 | Vanessa Abbood | Dietitian, Registered | 900 Eighth Ave, Fns Department, Fort Worth, TX 76104 | 2017-07-07 |
| 1922537562 | Nicole Marie Tod | Student in an Organized Health Care Education/Training Program | 1500 S Main Street, Fort Worth, TX 76104 | 2017-06-07 |
| 1770025934 | Micah Bonola | Chiropractor | 1300 W. Rosedale St, Ste. A, Fort Worth, TX 76104 | 2016-11-04 |
| 1518315894 | United Bioscience, LLC. | Clinical Medical Laboratory | 901 W. Leuda St., B, Fort Worth, TX 76104 | 2016-05-27 |
| Find all providers in zip 76104 | ||||
| Taxonomy Code | 207RC0200X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Critical Care Medicine |
| An internist who diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff and other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629581467 | The Lung Consultants LLC | Internal Medicine | 1325 Pennsylvania Ave Ste 370, Fort Worth, TX 76104-2110 | 2017-11-15 |
| 1174924450 | David Maldonado IIi Md Pa | Internal Medicine | 6551 Harris Pkwy Ste 250, Fort Worth, TX 76132-6115 | 2014-09-05 |
| 1700813383 | Daud H Ashai | Internal Medicine | 1001 College Avenue, Ste A, Fort Worth, TX 76104-3013 | 2006-06-27 |
| 1154371078 | Hisham Bismar | Internal Medicine | 11807 South Freeway, Ste 362, Fort Worth, TX 76115 | 2006-05-11 |
| 1881688331 | Kerim F Razack | Internal Medicine | 1521 Cooper St, Fort Worth, TX 76104-2711 | 2005-09-09 |
| 1134113913 | John T Pender Jr. | Internal Medicine | 1201 Fairmount Ave, Fort Worth, TX 76104-4215 | 2005-09-07 |
| 1053313882 | Kwaku A Osafo-mensah | Internal Medicine | 2550 River Park Dr, Suite 100, Fort Worth, TX 76116-0921 | 2005-08-11 |
| 1184071771 | Dfw Critical Care LLC | Internal Medicine | 1001 College Ave, Ste A, Fort Worth, TX 76104-3000 | 2016-05-24 |
| 1760877732 | Amanda Catherine Pientka | Internal Medicine | 1500 S Main St, Fort Worth, TX 76104-4917 | 2015-04-06 |
| 1972843415 | Lien-khuong Pham Tran | Internal Medicine | 1201 Fairmount Ave, Fort Worth, TX 76104-4215 | 2013-02-20 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76104 |
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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.