Mark Theodore, FNP-BC - Medicare Nurse Practitioner in Utica, NY

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Mark Theodore, FNP-BC is a medicare enrolled "Nurse Practitioner - Family" in Utica, New York. His current practice location is 1656 Champlin Ave, Utica, New York. You can reach out to his office (for appointments etc.) via phone at (315) 624-6000.

Mark Theodore is licensed to practice in New York (license number 338083) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1457793135.

Contact Information

Mark Theodore, FNP-BC
1656 Champlin Ave,
Utica, NY 13502-4830
(315) 624-6000
Not Available

Map and Direction




Provider's Profile

Full NameMark Theodore
GenderMale
SpecialityNurse Practitioner - Family
Location1656 Champlin Ave, Utica, New York
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1457793135
  • Provider Enumeration Date: 07/23/2013
  • Last Update Date: 07/23/2013
  Medicare PECOS Information:
  • PECOS PAC ID: 4385867332
  • Enrollment ID: I20140521000883

Medical Identifiers

Medical identifiers for Mark Theodore such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1457793135NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
163WC0200XRegistered Nurse - Critical Care Medicine 629932 (New York)Secondary
363LF0000XNurse Practitioner - Family 338083 (New York)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mark Theodore allows following entities to bill medicare on his behalf.
Entity NameNorth Shore Lij Urgent Care Pc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1679970891
PECOS PAC ID: 6002131778
Enrollment ID: O20150223000060

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mark Theodore is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Mark Theodore, FNP-BC
1656 Champlin Ave,
Utica, NY 13502-4830

Ph: (315) 624-6000		Mark Theodore, FNP-BC
1656 Champlin Ave,
Utica, NY 13502-4830

Ph: (315) 624-6000

Reviews and Comments


Nurse Practitioner Nurses in Utica, NY

Sarah Dunham, FNP
Nurse Practitioner
Medicare: Medicare Enrolled
Practice Location: 1650 Champlin Ave, Utica, NY 13502
Phone: 315-624-8400    
Cynthia A Altieri,
Nurse Practitioner
Medicare: Not Enrolled in Medicare
Practice Location: 1400 Noyes St, Utica, NY 13502
Phone: 315-797-6800    
Thet Thet Mar, NP
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 120 Hobart St, Utica, NY 13501
Phone: 315-798-1149    Fax: 315-734-3565
Barbara Jean Drake,
Nurse Practitioner
Medicare: Medicare Enrolled
Practice Location: 2211 Genesee St Ste 200, Utica, NY 13501
Phone: 315-733-7598    Fax: 315-733-7694
Michael S Babula, FNP
Nurse Practitioner
Medicare: Medicare Enrolled
Practice Location: 1001 Noyes St, Utica, NY 13502
Phone: 315-624-9471    Fax: 315-922-9502
Vicki A. Haines, NP
Nurse Practitioner
Medicare: Not Enrolled in Medicare
Practice Location: 1656 Champlin Ave, Suite 203, Utica, NY 13502
Phone: 315-738-0647    Fax: 315-738-9719
Mrs. Susan Mary Kolb, FNP-BC
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: Digestive Disease Medicine Of Cny, Llp, 116 Business Park Drive, 1st Floor, Utica, NY 13502
Phone: 315-624-7000    Fax: 315-793-1129

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.