MARK E. DONNELLY MD PC (NPI# 1588741623) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588741623 |
| Entity Type | Organization |
| Organization Name | MARK E. DONNELLY MD PC |
| Practice Address |
1200 N Beaver St Flagstaff AZ 86001-3118 |
| Mailing Address |
Po Box 1356 Flagstaff AZ 86002-1356 |
| Practice Telephone | 9287732200 |
| Practice Fax Number | 9287732201 |
| Mailing Telephone | 9287732200 |
| Mailing Fax Number | 9287732201 |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2008-01-23 |
| Authorized Official Name | MARK E DONNELLY (PRESIDENT) |
| Authorized Official Telephone | 9287732200 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | RAILROAD MEDICARE | DC4814 | 01 |
| Street Address |
1200 N BEAVER ST |
| City | FLAGSTAFF |
| State | AZ |
| Zip Code | 86001-3118 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346241189 | Alvin B Elisco | Internal Medicine | 1200 N Beaver St, Fmc Hospitalists, Flagstaff, AZ 86001-3118 | 2005-08-02 |
| 1285240515 | Amika Noel | Nurse Anesthetist, Certified Registered | 1200 N Beaver St, Flagstaff, AZ 86001-3118 | 2020-09-22 |
| 1669084190 | Margaret Grace Mcgough | Registered Nurse | 1200 N Beaver St, Flagstaff, AZ 86001-3118 | 2020-08-17 |
| 1942818398 | Regan Rowson | Registered Nurse | 1200 N Beaver St, Flagstaff, AZ 86001-3118 | 2020-07-21 |
| 1871118984 | Nancy Gloria Flores | Audiologist | 1200 N Beaver St, Flagstaff, AZ 86001-3118 | 2020-06-15 |
| 1679100705 | Kristy Anderson | Occupational Therapist | 1200 N Beaver St, Flagstaff, AZ 86001-3118 | 2020-03-26 |
| 1164058087 | Bryan J Ebeling | Nurse Practitioner | 1200 N Beaver St, Flagstaff, AZ 86001-3118 | 2020-03-23 |
| 1447808407 | Bryce Aldworth Randall | Registered Nurse | 1200 N Beaver St, Flagstaff, AZ 86001-3118 | 2019-09-03 |
| 1851952162 | Samuel Small | Nurse Practitioner | 1200 N Beaver St, Flagstaff, AZ 86001-3118 | 2019-06-26 |
| 1235797283 | Rebecca R Boger | Dietitian, Registered | 1200 N Beaver St, Flagstaff, AZ 86001-3118 | 2019-06-04 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427658756 | Marlenne Adair Escobar-mendoza | Specialist/Technologist | 1705 South San Francisco Street, Flagstaff, AZ 86001 | 2020-10-27 |
| 1962033712 | Laura-lee Prescott | Social Worker | Northern Az Va Healthcare System, Flagstaff Cboc, 1300 W. University Ave., Suite 300, Flagstaff, AZ 86001 | 2020-01-30 |
| 1194360784 | Trinity Medical Consultants Pllc | Internal Medicine | 1521 N Cliff Drive, Flagstaff, AZ 86001 | 2019-11-07 |
| 1154849610 | Altacare, LLC | Family Medicine | 2700 S Woodlands Village Blvd Ste 700, Flagstaff, AZ 86001 | 2017-09-05 |
| 1487174926 | Lindsey Marie Forstie | Nurse Practitioner | 7263 E Dreamview Trail, Flagstaff, AZ 86001 | 2017-06-26 |
| 1255860763 | Welbrook Senior Living Flagstaff LLC | Skilled Nursing Facility | 1521 N Pine Cliff Dr, Flagstaff, AZ 86001 | 2017-06-08 |
| 1912432675 | Ryan Tiscareno | Specialist/Technologist | 621 West Cherry Ave, Flagstaff, AZ 86001 | 2017-05-01 |
| 1629432380 | Behavioral Consultation Services, Inc. | Clinic/Center | 345 S. River Run Road, Suite 200, Flagstaff, AZ 86001 | 2016-04-08 |
| 1275920928 | Junli Gallagher | Speech-Language Pathologist | 1215 N. Beaver St, Flagstaff, AZ 86001 | 2015-04-21 |
| 1932592599 | Kristen Flugstad Psyd, LLC | Psychologist | 125 East Elm Avenue #203, Flagstaff, AZ 86001 | 2015-03-06 |
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| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538369384 | Ralph Zane Kelley | Surgery | 77 W Forest Ave Ste 206, Flagstaff, AZ 86001-1483 | 2007-07-20 |
| 1134325012 | Adam Keith Boettcher | Surgery | 1020 N San Francisco St Ste 200, Flagstaff, AZ 86001-3281 | 2007-06-26 |
| 1164685749 | Kristina W Bermas | Surgery | 77 W Forest Ave Ste 201, Flagstaff, AZ 86001-1483 | 2008-07-03 |
| 1265692982 | Kate Preston | Surgery | 77 W Forest Ave Ste 201, Flagstaff, AZ 86001-1483 | 2008-06-16 |
| 1255598900 | Nicole Renee Sydow | Surgery | 1215 N Beaver St, Suite 203, Flagstaff, AZ 86001-3126 | 2008-05-20 |
| 1578769683 | Brian Coates | Surgery | 77 W Forest Ave, Suite 201, Flagstaff, AZ 86001-1479 | 2007-06-25 |
| 1194809699 | Northern Arizona Surgical | Surgery | 77 W Forest Ave, #202, Flagstaff, AZ 86001-1479 | 2006-10-24 |
| 1407944416 | Eric Davis Kendle | Surgery | 77 W Forest Ave, Suite 202, Flagstaff, AZ 86001-1479 | 2006-10-11 |
| 1851330393 | John E Hildebrand | Surgery | 1215 N Beaver St, Suite 202, Flagstaff, AZ 86001-3126 | 2006-06-06 |
| 1497724017 | Andrew J Aldridge | Surgery | 77 W Forest Ave Ste 201, Flagstaff, AZ 86001-1483 | 2006-03-16 |
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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.