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Deactivated NPI 1417920497 Deactivated / Inactive NPI Male Practitioner

Dr. Mark Edward Withrow , MD

General Practice • Kodiak, AK

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Mark Withrow has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date February 09, 2006
NPI Deactivation Date April 10, 2025
Total Practice Duration ~19 Years of Practice (2006 – 2025)

Professional Overview & Biography Verified Profile Summary

Dr. Mark Withrow, MD was a registered General Practice practicing in Kodiak, AK. Throughout an active medical career spanning 19 years, Dr. Withrow provided care at the practice location at 1818 E REZANOF DR until profile deactivation on 2025-04-10.

Historical Medicare Part B clinical services included established patient outpatient office visit, blood test, clotting time, outpatient office visit. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

1818 E Rezanof Dr

Kodiak, AK 99615

Telephone 9074866065
Fax 9074862248
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for General Practice in Kodiak, AK

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 25.6 Yrs
Regional Practice Density
10 Specialists

Practicing in Kodiak, AK (51 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
55.2% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2017)
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes
20 18 $160.00 $89.51
85610 Blood test, clotting time
16 14 $70.00 $5.28
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional
13 12 $35.00 $23.80

Medical Specialties & State Licenses

General Practice Primary Specialty

NUCC Taxonomy Code: 208D00000X

State License AK AA1478

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

6 Associated Practitioners
Rae Jean Blaschka , NP

Nurse Practitioner

NPI 1093788994

Nurse Practitioner

Dr. Carol Juergens , MD

Internal Medicine

NPI 1174591325

Doctor of Medicine (M.D.)

Dr. Shawn Vainio , MD

Family Medicine

NPI 1205930914

Doctor of Medicine (M.D.)

Dr. Stephen Burnside , MD

Internal Medicine

NPI 1225004401

Doctor of Medicine (M.D.)

Greg Mete , PA-C

Physician Assistant

NPI 1538132519

Physician Assistant (Certified)

Dr. Jeremy Larson , MD

Family Medicine

NPI 1548366891

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated April 10, 2025

Record deactivated on April 10, 2025

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 1818 E REZANOF DR, KODIAK, AK 99615 (Tel: 9074866065)

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Updated Business Mailing Address July 08, 2007

Registered at 1818 E REZANOF DR, KODIAK, AK 99615 (Tel: 9074866065)

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Provider Name / Credentials Updated July 08, 2007

Recorded as MARK WITHROW, MD

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

General Practice (License #AA1478 in AK)

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Initial NPI Registration & Enumeration February 09, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1417920497
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: February 09, 2006
Last Update: July 08, 2007
Deactivation Date: April 10, 2025

Mailing Address

1818 E Rezanof Dr

Kodiak, AK 99615

Phone: 9074866065

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.