MR. MARK THOMAS BANOVETZ JR. MD
NPI 1164124350
Student in an Organized Health Care Education/Training Program in Kalamazoo, MI

Q: What is Mark Banovetz's NPI number?

The NPI number for Mark Banovetz is 1164124350. It was assigned to this individual provider in the NPPES registry on March 20, 2023.

Q: What is Mark Banovetz's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Mark Banovetz was last updated on May 21, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 20, 2023PECOS Enrolled

1000 OAKLAND DR, KALAMAZOO, MI 49008(269) 337-4600 Get Directions Write a Review

NPPES record last updated: May 21, 2025. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: May 21, 2025, Mar 20, 2023 (2 updates tracked since 2023).

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About Mr. Mark Thomas Banovetz Jr. Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. MARK THOMAS BANOVETZ JR. MD (NPI 1164124350) is an individual student in an organized health care education/training program in Kalamazoo, Michigan, licensed in Michigan (4351054332) and active in the NPI registry since March 2023. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1164124350

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameMR. MARK THOMAS BANOVETZ JR.Credential: MD

Location Address1000 OAKLAND DRKalamazoo, MI 49008-1282

Mailing Address1000 Oakland DriveKalamazoo, MI 49008-8000 · (269) 337-4400

Phone(269) 337-4600

Sole ProprietorYes

Enumeration DateMarch 20, 2023

Last NPPES UpdateMay 21, 20252 updates tracked since enumeration

NPPES CertifiedMay 21, 2025

✔ NPI 1164124350 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

License✔ Licensed in MI · 4351054332

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

1000 OAKLAND DR, Kalamazoo, MI 49008

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Mark Thomas Banovetz Jr. Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANDREW MATTINGLY MD

Student in an Organized Health Care Education/Training Program